Healthcare Provider Details

I. General information

NPI: 1336115252
Provider Name (Legal Business Name): DANIEL S PLAX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD STE 100
SAINT LOUIS MO
63124-2326
US

IV. Provider business mailing address

PO BOX 7412125
CHICAGO IL
60674-2125
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-4050
  • Fax: 314-862-1141
Mailing address:
  • Phone: 314-862-4050
  • Fax: 314-862-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number104090
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: