Provider Demographics
NPI:1609832476
Name:AMATO, JASON B (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:B
Last Name:AMATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N NEW BALLAS RD
Mailing Address - Street 2:STE 203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6819
Mailing Address - Country:US
Mailing Address - Phone:314-569-3323
Mailing Address - Fax:314-569-3358
Practice Address - Street 1:522 N NEW BALLAS RD
Practice Address - Street 2:STE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6819
Practice Address - Country:US
Practice Address - Phone:314-569-3323
Practice Address - Fax:314-569-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO457893OtherHEALTHLINK
MO143496OtherBLUE CROSS BLUE SHIELD
MO7111216OtherAETNA
MO070015818OtherRAIL ROAD MEDICARE
MO7111216OtherAETNA
MOH32029Medicare UPIN