Individual
DR. ALI KHOJASTEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 893-6404
(573) 893-6505
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 893-6404
(573) 893-6505
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
R9764
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110037534
RAILROAD MEDICARE
MO
01
—
110080769
RAILROAD MEDICARE
MO
05
—
201083326
—
MO
Enumeration date
03/20/2006
Last updated
11/29/2011
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