Healthcare Provider Details

I. General information

NPI: 1093829723
Provider Name (Legal Business Name): DANIEL L. SEXTON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 DUNN RD
FLORISSANT MO
63031-7928
US

IV. Provider business mailing address

13044 WHEATFIELD FARM RD
SAINT LOUIS MO
63141-8548
US

V. Phone/Fax

Practice location:
  • Phone: 314-837-2882
  • Fax: 314-837-6465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR5831
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: