Healthcare Provider Details

I. General information

NPI: 1417062407
Provider Name (Legal Business Name): BLASE J PIGNOTTI M.D.,F.A.C.O.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD TOWER B, SUITE 75
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD TOWER B, SUITE 75
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7564
  • Fax: 314-251-7554
Mailing address:
  • Phone: 314-251-7564
  • Fax: 314-251-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0700118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: