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NPI Code Detail

MEDICARE: JAMES SERTL M.D.

MEDICARE:   JAMES  SERTL  M.D.
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
1207R00000XInternal Medicine Physician30587MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12193977OTHERMOAETNA US
20400282OTHERMOUHC
3127491OTHERMOGHP
4136657OTHERMOHEALTHLINK
52193977OTHERMOAETNA
65606453OTHERAETNA
7000000010036OTHERMOESSENCE
8100623OTHERMOBCBS
9D83432OTHERMOMERCY

General Provider Information

NPI Number : 1861473241
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES SERTL M.D.
Provider Business Mailing Address
First Line : PO BOX 23340
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63156-3340
Country : US
Telephone Number : 314-851-1075
Fax Number : 314-851-4477
Provider Business Practice Location Address
First Line : 1034 S BRENTWOOD BLVD
Second Line : SUITE 816
City : SAINT LOUIS
State : MO
Zip : 63117-1223
Country : US
Telephone Number : 314-863-7766
Fax Number : 314-863-5250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 03/18/2008

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