Healthcare Provider Details

I. General information

NPI: 1619965316
Provider Name (Legal Business Name): DANIEL J SCODARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

2407 COUNTRY POINTE LN
WENTZVILLE MO
63385-5435
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1000
  • Fax:
Mailing address:
  • Phone: 314-960-0760
  • Fax: 636-332-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME127387
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR8N28
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: