Healthcare Provider Details

I. General information

NPI: 1063538015
Provider Name (Legal Business Name): GREGORY DEWITT FOLKERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT ANTHONYS WAY
ALTON IL
62002-4568
US

IV. Provider business mailing address

331 N NEW BALLAS RD UNIT 410864
SAINT LOUIS MO
63141-5537
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-2571
  • Fax:
Mailing address:
  • Phone: 314-744-9131
  • Fax: 314-747-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.150967
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2008008950
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: