Healthcare Provider Details

I. General information

NPI: 1922126788
Provider Name (Legal Business Name): GERALD SHATZ, M. D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD SUITE 111 NORTH
SAINT LOUIS MO
63136-6150
US

IV. Provider business mailing address

11155 DUNN RD SUITE 111 NORTH
SAINT LOUIS MO
63136-6150
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-8200
  • Fax: 314-741-2838
Mailing address:
  • Phone: 314-741-8200
  • Fax: 314-741-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR8059
License Number StateMO

VIII. Authorized Official

Name: DR. GERALD S SHATZ
Title or Position: OWNER
Credential: M. D.
Phone: 314-741-8200