Provider Demographics
NPI:1902881279
Name:JAMRY, WIT ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:WIT
Middle Name:ANTHONY
Last Name:JAMRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7137 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4417
Mailing Address - Country:US
Mailing Address - Phone:314-721-0675
Mailing Address - Fax:314-721-2830
Practice Address - Street 1:5621 DELMAR BLVD
Practice Address - Street 2:#105
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2656
Practice Address - Country:US
Practice Address - Phone:314-367-2727
Practice Address - Fax:314-367-2989
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 37003207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203167226Medicaid
110160439OtherRAILROAD MEDICARE
MO001013240Medicare ID - Type Unspecified
MOF02137Medicare UPIN
MO203167226Medicaid