Healthcare Provider Details

I. General information

NPI: 1942756705
Provider Name (Legal Business Name): JACK YACOOB EL SAWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV IM HOSPITALIST
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8058
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1700
  • Fax: 314-362-9878
Mailing address:
  • Phone: 314-362-1700
  • Fax: 314-362-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019024545
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019024545
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101280909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: