Healthcare Provider Details

I. General information

NPI: 1902123474
Provider Name (Legal Business Name): DAVID SHAI OLANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 KINGSBURY BLVD
SAINT LOUIS MO
63130-4306
US

IV. Provider business mailing address

7114 KINGSBURY BLVD
SAINT LOUIS MO
63130-4306
US

V. Phone/Fax

Practice location:
  • Phone: 314-863-7015
  • Fax:
Mailing address:
  • Phone: 314-863-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR6412
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: