Provider Demographics
NPI:1952393191
Name:RAI, JODIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:
Last Name:RAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 352-C
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-996-4010
Mailing Address - Fax:
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 352-C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-395-8192
Practice Address - Fax:314-395-8196
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101761174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111599OtherBLUE CROSS BLUE SHIELD
MO177835OtherHEALTHLINK
MO516V38088OtherGROUP HEALTH PLAN
MO0701032OtherUNITED HEALTH CARE
MO0701032OtherUNITED HEALTH CARE
MO177835OtherHEALTHLINK