Healthcare Provider Details

I. General information

NPI: 1720041395
Provider Name (Legal Business Name): JAMSHED GUL AGHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD SUITE 180
SAINT CHARLES MO
63304-8781
US

IV. Provider business mailing address

500 MEDICAL DRIVE
WENTZVILLE MO
63385
US

V. Phone/Fax

Practice location:
  • Phone: 636-442-7300
  • Fax: 636-442-7319
Mailing address:
  • Phone: 636-327-1202
  • Fax: 636-327-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2002016138
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: