Healthcare Provider Details

I. General information

NPI: 1508327891
Provider Name (Legal Business Name): JOSHUA TRIERWEILER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SOUTHFORK RD STE 260
SAINT LOUIS MO
63128-3288
US

IV. Provider business mailing address

12700 SOUTHFORK RD STE 260
SAINT LOUIS MO
63128-3288
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5270
  • Fax: 314-543-5272
Mailing address:
  • Phone: 314-543-5270
  • Fax: 314-543-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD61533762
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2026034656
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: