Healthcare Provider Details

I. General information

NPI: 1386645794
Provider Name (Legal Business Name): RICHARD E. HULSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD DES PERES RD SUITE 100
SAINT LOUIS MO
63131-1873
US

IV. Provider business mailing address

1050 OLD DES PERES RD SUITE 100
SAINT LOUIS MO
63131-1873
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0612
  • Fax: 314-966-0664
Mailing address:
  • Phone: 314-569-0612
  • Fax: 314-966-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36484
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: