Healthcare Provider Details

I. General information

NPI: 1710068705
Provider Name (Legal Business Name): SCOTT H BURNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1026
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8072
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-9123
  • Fax: 314-747-3338
Mailing address:
  • Phone: 314-362-9123
  • Fax: 314-747-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2008025163
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: