Healthcare Provider Details

I. General information

NPI: 1295752749
Provider Name (Legal Business Name): WILLIAM HARRY DRIBBEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KINGSHIGHWAY BLVD DEPT EMERGENCY MEDICINE
SAINT LOUIS MO
63110-1014
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-362-9123
  • Fax: 314-747-3338
Mailing address:
  • Phone: 314-747-3000
  • Fax: 314-747-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number2000146631
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2000146631
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2000146631
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: