Healthcare Provider Details

I. General information

NPI: 1538270624
Provider Name (Legal Business Name): JAMES RAYMOND PROBST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 WATSON RD
ST LOUIS MO
63127
US

IV. Provider business mailing address

10345 WATSON RD
ST LOUIS MO
63127
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-6033
  • Fax: 314-965-6067
Mailing address:
  • Phone: 314-965-6033
  • Fax: 314-965-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR3J87
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR3J87
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberR3J87
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3J87
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: