Individual
DR. JACQUES S VAN RYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11125 DUNN RD STE 301, SAINT LOUIS, MO 63136-6132
(314) 953-8250
(314) 953-8255
Mailing address
11125 DUNN RD STE 301, SAINT LOUIS, MO 63136-6132
(314) 953-8250
(314) 953-8255
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
R4G45
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000603706
BLUE CROSS BLUE SHIELD
MO
01
—
101252
HEALTHLINK
MO
01
—
116020001
MEDICARE
MO
01
—
4048872
AETNA
MO
01
—
475415
GROUP HEALTH PLAN
MO
01
—
P00727699
MEDICARE RAILROAD
MO
Enumeration date
02/08/2006
Last updated
03/12/2020
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