Healthcare Provider Details

I. General information

NPI: 1003558610
Provider Name (Legal Business Name): ERIC A DARDEN JR. SGT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLIVE 1430 OLIVE 400 STE
SAINT LOUIS MO
63103
US

IV. Provider business mailing address

1430 ST STE 400
SAINT LOUIS MO
63103
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3700
  • Fax:
Mailing address:
  • Phone: 314-788-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: