Healthcare Provider Details

I. General information

NPI: 1437843240
Provider Name (Legal Business Name): AGANS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 LINDELL BLVD
SAINT LOUIS MO
63108-1510
US

IV. Provider business mailing address

4625 LINDELL BLVD # 311
SAINT LOUIS MO
63108-3725
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN AGANS
Title or Position: OWNER
Credential:
Phone: 504-352-7856