Healthcare Provider Details

I. General information

NPI: 1265807416
Provider Name (Legal Business Name): DONNA R MCCALL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2015
Last Update Date: 12/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 S LINDBERGH BLVD
SAINT LOUIS MO
63125-4843
US

IV. Provider business mailing address

6915 FOXCROFT DR
SAINT LOUIS MO
63123-1637
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-2803
  • Fax:
Mailing address:
  • Phone: 314-706-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberR5H81
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: