Healthcare Provider Details

I. General information

NPI: 1689773541
Provider Name (Legal Business Name): ROBERT KOCUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S NEW BALLAS RD SUITE 216W
SAINT LOUIS MO
63141-8705
US

IV. Provider business mailing address

777 S NEW BALLAS RD SUITE 216W
SAINT LOUIS MO
63141-8705
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2015
  • Fax: 314-569-2016
Mailing address:
  • Phone: 314-569-2015
  • Fax: 314-569-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR7H71
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: