Provider Demographics
NPI:1144250028
Name:KHOURY, JAD ANTOINE (MD)
Entity type:Individual
Prefix:DR
First Name:JAD
Middle Name:ANTOINE
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 7018
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-4949
Mailing Address - Fax:314-251-4368
Practice Address - Street 1:621 S NEW BALLAS RD # 7018
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-4949
Practice Address - Fax:314-251-4368
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015237207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO938062024Medicare PIN
MOI47833Medicare UPIN