MEDICARE: JESSE IAN CRAYLE MD

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	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	2023017590	MO
2	2084N0400X	Neurology Physician	2023017590	MO
3	2084A2900X	Neurocritical Care Physician	2023017590	MO

General Provider Information

NPI Number	:	1528684123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE IAN CRAYLE MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	CAMPUS BOX 8111
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-362-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BARNES JEWISH HOSPITAL PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:	314-362-5000
Fax Number	:

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

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	04/08/2026

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