Healthcare Provider Details

I. General information

NPI: 1699193748
Provider Name (Legal Business Name): SARAH S TRAVERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 125
SAINT LOUIS MO
63141-8663
US

IV. Provider business mailing address

12855 N 40 DR STE 125
SAINT LOUIS MO
63141-8663
US

V. Phone/Fax

Practice location:
  • Phone: 314-806-1770
  • Fax:
Mailing address:
  • Phone: 314-806-1770
  • Fax: 314-558-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberDR.0066220
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2015017274
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036160043
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2022026024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: