Healthcare Provider Details

I. General information

NPI: 1205008976
Provider Name (Legal Business Name): ST LOUIS PATHOLOGY ASSOC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 OFFICE PKWY
SAINT LOUIS MO
63141-7103
US

IV. Provider business mailing address

660 OFFICE PKWY
SAINT LOUIS MO
63141-7103
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-8015
  • Fax:
Mailing address:
  • Phone: 314-991-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number110857
License Number StateMO

VIII. Authorized Official

Name: DR. BARRY G CORDES
Title or Position: PATHOLOGIST
Credential: M.D.
Phone: 314-991-8015