Healthcare Provider Details

I. General information

NPI: 1063420933
Provider Name (Legal Business Name): STEVEN M PINCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

3655 VISTA AVE
SAINT LOUIS MO
63110-2539
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-6057
  • Fax: 314-773-1167
Mailing address:
  • Phone: 314-577-6057
  • Fax: 314-773-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number108688
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: