Healthcare Provider Details

I. General information

NPI: 1376731828
Provider Name (Legal Business Name): CONSULTANTS IN OB GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE399
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE399
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6644
  • Fax: 314-251-6891
Mailing address:
  • Phone: 314-251-6644
  • Fax: 314-251-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number32180
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT L BECKER
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 314-251-6644