Healthcare Provider Details

I. General information

NPI: 1033254248
Provider Name (Legal Business Name): FOREST PARK PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 FOREST PARK AVE SUITE 230
SAINT LOUIS MO
63108-2215
US

IV. Provider business mailing address

4488 FOREST PARK AVE SUITE 230
SAINT LOUIS MO
63108-2215
US

V. Phone/Fax

Practice location:
  • Phone: 314-535-7855
  • Fax: 314-534-2803
Mailing address:
  • Phone: 314-535-7855
  • Fax: 314-534-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAIL L MCCARTHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-535-7855