Healthcare Provider Details

I. General information

NPI: 1003895236
Provider Name (Legal Business Name): JOSEPH M OJILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 TESSON FERRY RD SUITE 100
SAINT LOUIS MO
63123-6922
US

IV. Provider business mailing address

11222 TESSON FERRY RD SUITE 100
SAINT LOUIS MO
63123-6963
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-1500
  • Fax: 314-849-8789
Mailing address:
  • Phone: 314-849-1500
  • Fax: 314-849-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR3F72
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: