Healthcare Provider Details

I. General information

NPI: 1528028065
Provider Name (Legal Business Name): DAVID L MCCOLLISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 1ST CAPITOL DR
SAINT CHARLES MO
63301-2880
US

IV. Provider business mailing address

1551 WALL ST SUITE 310
SAINT CHARLES MO
63303-3539
US

V. Phone/Fax

Practice location:
  • Phone: 636-669-2332
  • Fax: 636-669-2401
Mailing address:
  • Phone: 636-669-2268
  • Fax: 636-669-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR4G88
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: