Healthcare Provider Details

I. General information

NPI: 1215046263
Provider Name (Legal Business Name): JULIA M MAYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA M BECKER

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD STE 32W
CHESTERFIELD MO
63017-3442
US

IV. Provider business mailing address

226 S WOODS MILL RD STE 32W
CHESTERFIELD MO
63017-3442
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-1616
  • Fax: 314-576-5271
Mailing address:
  • Phone: 314-576-1616
  • Fax: 314-576-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number112912
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: