Healthcare Provider Details

I. General information

NPI: 1972567923
Provider Name (Legal Business Name): INSTITUTE FOR RESEARCH AND EDUCATION IN FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9417 S BROADWAY
SAINT LOUIS MO
63125-2009
US

IV. Provider business mailing address

5501 DELMAR BLVD STE B560
SAINT LOUIS MO
63112-3084
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-4030
  • Fax: 314-833-4031
Mailing address:
  • Phone: 314-833-4030
  • Fax: 314-833-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1H15
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID C CAMPBELL
Title or Position: CEO
Credential: MD
Phone: 314-833-4030