Healthcare Provider Details

I. General information

NPI: 1043236276
Provider Name (Legal Business Name): RICHARD A CHOLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE 3S STE 3S
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8115
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6162
  • Fax: 314-454-2174
Mailing address:
  • Phone: 314-362-7509
  • Fax: 314-747-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number114392
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: