Healthcare Provider Details

I. General information

NPI: 1124045729
Provider Name (Legal Business Name): ROBERT TARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
SAINT LOUIS MO
63136-6119
US

IV. Provider business mailing address

75 REMITT DRIVE LOCKBOX 6810
CHICAGO IL
60675-6810
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax:
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: