Healthcare Provider Details

I. General information

NPI: 1497982771
Provider Name (Legal Business Name): TIMOTHY JOSEPH VREELAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/01/2022
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 KENNERLY RD STE 1500
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

10050 KENNERLY RD STE 1500
SAINT LOUIS MO
63128-2106
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1545
  • Fax:
Mailing address:
  • Phone: 314-525-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2016015484
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: