Healthcare Provider Details

I. General information

NPI: 1861484784
Provider Name (Legal Business Name): RAND W SOMMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SAINT LUKES CENTER DR STE 506
CHESTERFIELD MO
63017-3519
US

IV. Provider business mailing address

506 ST LUKES CENTER DR SUITE 506
CHESTERFIELD MO
63017-3509
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-8102
  • Fax: 314-590-5930
Mailing address:
  • Phone: 314-576-8102
  • Fax: 314-576-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMDR3D27
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3D27
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: