Provider Demographics
NPI:1497931729
Name:SKYLES, JASON K (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:K
Last Name:SKYLES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11475 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7128
Mailing Address - Country:US
Mailing Address - Phone:314-991-8210
Mailing Address - Fax:314-991-8206
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-6031
Practice Address - Fax:314-251-6343
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2016-02-05
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Provider Licenses
StateLicense IDTaxonomies
NC2008-009572085R0202X
MO20010026162085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1497931729Medicaid
MO107690011Medicare PIN
MO1497931729Medicaid