Healthcare Provider Details

I. General information

NPI: 1235337932
Provider Name (Legal Business Name): DAVID A. STOECKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

549 HUNTERCREEK RIDGE CT
SAINT LOUIS MO
63131-2233
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8856
  • Fax:
Mailing address:
  • Phone: 314-909-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number113514
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number113514
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: