Healthcare Provider Details

I. General information

NPI: 1104911288
Provider Name (Legal Business Name): EAR NOSE & THROAT & PLASTIC SURG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DOUGHERTY FERRY RD STE 106
SAINT LOUIS MO
63122-3356
US

IV. Provider business mailing address

2325 DOUGHERTY FERRY RD STE 106
SAINT LOUIS MO
63122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-5002
  • Fax: 314-821-5029
Mailing address:
  • Phone: 314-821-5002
  • Fax: 314-821-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: RICHARD L BARNES
Title or Position: PRESIDENT
Credential: DO
Phone: 314-821-5002