Healthcare Provider Details

I. General information

NPI: 1013919562
Provider Name (Legal Business Name): NOEL FRANCIS WEYERICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR SUITE 280
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

901 PATIENTS FIRST DR
WASHINGTON MO
63090-4700
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-4415
  • Fax: 314-432-1986
Mailing address:
  • Phone: 636-390-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMO 29614
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: