Healthcare Provider Details

I. General information

NPI: 1841988995
Provider Name (Legal Business Name): VINCE ANTHONY CORRO GARIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

3416 VIRGINIA AVE
SAINT LOUIS MO
63118-2829
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6000
  • Fax:
Mailing address:
  • Phone: 408-628-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2026021494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: