Healthcare Provider Details

I. General information

NPI: 1588014757
Provider Name (Legal Business Name): ELIZABETH ANN WEGLEITNER M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 09/28/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DES PERES RD STE 300
SAINT LOUIS MO
63131-2040
US

IV. Provider business mailing address

1000 DES PERES RD STE 300
SAINT LOUIS MO
63131-2040
US

V. Phone/Fax

Practice location:
  • Phone: 314-919-2600
  • Fax:
Mailing address:
  • Phone: 314-919-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2016020418
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: