Provider Demographics
NPI:1487737615
Name:MCDONALD, JAY R (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:915 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1621
Mailing Address - Country:US
Mailing Address - Phone:314-652-4100
Mailing Address - Fax:314-289-6389
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-6389
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034063207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204025704Medicaid
MO204025704Medicaid
I68612Medicare UPIN
962710183Medicare PIN
MO204025704Medicaid