Provider Demographics
NPI:1538270624
Name:PROBST, JAMES RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RAYMOND
Last Name:PROBST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-965-6033
Mailing Address - Fax:314-965-6067
Practice Address - Street 1:10345 WATSON RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-965-6033
Practice Address - Fax:314-965-6067
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3J87207QA0505X, 207V00000X, 207VG0400X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5790OtherMEDICARE NUMBER 5790
MO5790Medicare PIN
MO1538270624Medicare PIN
D42432Medicare UPIN