Provider Demographics
NPI:1720041395
Name:AGHA, JAMSHED GUL (MD)
Entity Type:Individual
Prefix:
First Name:JAMSHED
Middle Name:GUL
Last Name:AGHA
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 1:500 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-327-1202
Mailing Address - Fax:636-327-1222
Practice Address - Street 1:1475 KISKER RD
Practice Address - Street 2:SUITE 180
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8781
Practice Address - Country:US
Practice Address - Phone:636-442-7300
Practice Address - Fax:636-442-7319
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016138207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1360100OtherUHC
MO173279OtherBCBS
5469243OtherAETNA
900004419OtherRR MEDICARE
MO205972300Medicaid
143463OtherGHP
633997OtherHEALTHLINK
MO000095542Medicare ID - Type Unspecified
143463OtherGHP