Healthcare Provider Details

I. General information

NPI: 1063483816
Provider Name (Legal Business Name): ORTHOPEDIC SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DOUGHERTY FERRY RD SUITE 200
SAINT LOUIS MO
63122-3356
US

IV. Provider business mailing address

PO BOX 790051
SAINT LOUIS MO
63179-0051
US

V. Phone/Fax

Practice location:
  • Phone: 314-909-1359
  • Fax: 314-909-1370
Mailing address:
  • Phone: 314-989-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2005025486
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR8G14
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR1F60
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number112753
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2003002791
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number105231
License Number StateMO

VIII. Authorized Official

Name: MICHAEL CHABOT
Title or Position: DELEGATED OFFICIAL
Credential: DO
Phone: 314-909-1359