Healthcare Provider Details

I. General information

NPI: 1376515569
Provider Name (Legal Business Name): GERALD S SHATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 DUNN RD
FLORISSANT MO
63031-7928
US

IV. Provider business mailing address

253 DUNN RD
FLORISSANT MO
63031-7928
US

V. Phone/Fax

Practice location:
  • Phone: 314-838-3948
  • Fax: 314-830-3593
Mailing address:
  • Phone: 314-838-3948
  • Fax: 314-830-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR8059
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: