MEDICARE: DR. JAMES THOMAS DOLL D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	2000160486	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	179266	OTHER	MO	BLUE CROSS BLUE SHIELD
2	7348439	OTHER	MO	AETNA
3	9949640001	OTHER	MO	CIGNA
4	H78278	OTHER	MO	MERCY #80
5	48117	OTHER	MO	EXCLUSIVE CHOICE
6	614098	OTHER	MS	HEALTHLINK
7	168382	OTHER	MO	GHP
8	2300376	OTHER	MO	UNITHED HEALTH CARE

General Provider Information

NPI Number	:	1134108830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES THOMAS DOLL D.O.

Provider Business Mailing Address
First Line	:	307 JEFFERSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-3629
Country	:	US
Telephone Number	:	314-991-4344
Fax Number	:	314-991-4345

Provider Business Practice Location Address
First Line	:	633 EMERSON RD
Second Line	:	SUITE 100
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6739
Country	:	US
Telephone Number	:	314-991-4344
Fax Number	:	314-991-4345

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	11/23/2015

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Directions to “ DR. JAMES THOMAS DOLL D.O.” Practice Location

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