Healthcare Provider Details

I. General information

NPI: 1891881140
Provider Name (Legal Business Name): ARTURO C. TACA, JR., M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11477 OLDE CABIN RD SUITE 210
CREVE COEUR MO
63141
US

IV. Provider business mailing address

1407 BOBOLINK PL
BRENTWOOD MO
63144-1128
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-5208
  • Fax: 314-997-5368
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2006024384
License Number StateMO

VIII. Authorized Official

Name: DR. ARTURO CALVO TACA JR.
Title or Position: MANAGER
Credential: MD
Phone: 314-259-1531