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NPI Code Detail

MEDICARE: DALE E DOERR, M.D. LLC

MEDICARE: DALE E DOERR, M.D. LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1114955861
Entity Type Code : Organization
Provider Name (Legal Business Name) : DALE E DOERR, M.D. LLC
Provider Business Mailing Address
First Line : 12639 OLD TESSON RD
Second Line : SUITE 115
City : SAINT LOUIS
State : MO
Zip : 63128-2786
Country : US
Telephone Number : 314-849-0311
Fax Number : 314-849-4423
Provider Business Practice Location Address
First Line : 3934 S BROADWAY
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-4626
Country : US
Telephone Number : 314-664-8600
Fax Number : 314-771-6758
Authorized Official
Title or Position : PRESIDENT
Name : DR. DALE E DOERR
Credential : M.D.
Telephone Number : 314-849-0311
Provider Enumeration Date : 06/30/2006
Last Update Date : 08/22/2020

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