Healthcare Provider Details

I. General information

NPI: 1295132835
Provider Name (Legal Business Name): CARLOS E HIMPLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CRAIG RD SUITE 230
SAINT LOUIS MO
63141-7138
US

IV. Provider business mailing address

777 CRAIG RD
SAINT LOUIS MO
63141-7138
US

V. Phone/Fax

Practice location:
  • Phone: 225-303-1055
  • Fax:
Mailing address:
  • Phone: 225-303-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number460639500
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number460639500
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: