Provider Demographics
NPI:1588616601
Name:DON, IRL J (MD)
Entity Type:Individual
Prefix:DR
First Name:IRL
Middle Name:J
Last Name:DON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8121-0022-07
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5060
Mailing Address - Fax:314-362-6959
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV IM GENERAL MED, STE 241
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-5060
Practice Address - Fax:314-362-6959
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-09-21
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Provider Licenses
StateLicense IDTaxonomies
MOR3E59207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206768608Medicaid
MO005013367Medicare ID - Type UnspecifiedMEDICARE SERVICES