Healthcare Provider Details

I. General information

NPI: 1477562965
Provider Name (Legal Business Name): ST LOUIS HEMATOLOGY ONCOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CLAYTON RD SUITE 302
SAINT LOUIS MO
63117-1850
US

IV. Provider business mailing address

6400 CLAYTON RD SUITE 302
SAINT LOUIS MO
63117-1850
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-3370
  • Fax: 314-645-0576
Mailing address:
  • Phone: 314-645-3370
  • Fax: 314-645-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR8B76
License Number StateMO

VIII. Authorized Official

Name: DEBORAH GONZALEZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 314-645-3370