Healthcare Provider Details

I. General information

NPI: 1881770451
Provider Name (Legal Business Name): JASON SCOTT SHELLHAAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKINGS DR
SAINT LOUIS MO
63130-4862
US

IV. Provider business mailing address

1 BROOKINGS DRIVE MSC 1201-323-100
ST LOUIS MO
63130-4899
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6666
  • Fax: 314-696-1214
Mailing address:
  • Phone: 314-935-6666
  • Fax: 314-696-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number2022043202
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022043202
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: