MEDICARE: DR. SHERWYN JORDAN WAYNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	R2534	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4486219	OTHER	MO	AETNA
2	A12955	OTHER	MO	MERCY #80
3	17900	OTHER	MO	BLUE CROSS BLUE SHIELD
4	101316	OTHER	MO	HEALTHLINK
5	49824	OTHER	MO	GHP
6	1495881002	OTHER	MO	CIGNA
7	009032	OTHER	MO	EXCLUSIVE CHOICE
8	0900078	OTHER	MO	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1194704833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERWYN JORDAN WAYNE M.D.

Provider Business Mailing Address
First Line	:	800 S HANLEY RD
Second Line	:	#7D
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-2687
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S KIRKWOOD RD
Second Line	:	SUITE 120
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-7254
Country	:	US
Telephone Number	:	314-966-8887
Fax Number	:	314-966-3869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. SHERWYN JORDAN WAYNE M.D.” Practice Location

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