Healthcare Provider Details

I. General information

NPI: 1457559080
Provider Name (Legal Business Name): EUGENE KELLY GESSERT AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WINDING WOODS DR STE 208A
O FALLON MO
63366-4773
US

IV. Provider business mailing address

31 WINDING STAIR WAY
O FALLON MO
63368-6125
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5850
  • Fax:
Mailing address:
  • Phone: 636-728-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number100196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: