Healthcare Provider Details

I. General information

NPI: 1497029219
Provider Name (Legal Business Name): AMY M MADDIN DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9937 BIG BEND BLVD
SAINT LOUIS MO
63122-6503
US

IV. Provider business mailing address

9937 BIG BEND BLVD
SAINT LOUIS MO
63122-6503
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-7600
  • Fax:
Mailing address:
  • Phone: 314-822-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2010013291
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: