Healthcare Provider Details

I. General information

NPI: 1508803644
Provider Name (Legal Business Name): RONALD E SEIGEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROGRESS POINT CT
O FALLON MO
63368-2208
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8054
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-1170
  • Fax: 636-344-1138
Mailing address:
  • Phone: 636-344-1170
  • Fax: 636-344-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number067059
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: