Healthcare Provider Details

I. General information

NPI: 1013477454
Provider Name (Legal Business Name): HEATHER ESCHBACH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-6100
  • Fax: 314-977-6164
Mailing address:
  • Phone: 314-977-6100
  • Fax: 314-977-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022044642
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: