Healthcare Provider Details

I. General information

NPI: 1396067328
Provider Name (Legal Business Name): SETH GENGLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 5015B
SAINT LOUIS MO
63141-8270
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 5015B
SAINT LOUIS MO
63141-8270
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7070
  • Fax:
Mailing address:
  • Phone: 314-251-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number5101018944
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2018011903
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: