Healthcare Provider Details

I. General information

NPI: 1235365776
Provider Name (Legal Business Name): DANIEL ROBERT HERLETH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GRAHAM RD STE C-2320
FLORISSANT MO
63031-8030
US

IV. Provider business mailing address

1225 GRAHAM RD STE C-1350
FLORISSANT MO
63031-8022
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-6801
  • Fax:
Mailing address:
  • Phone: 314-953-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011004653
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: