Healthcare Provider Details

I. General information

NPI: 1558362384
Provider Name (Legal Business Name): GRETCHEN ANNE MEYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 N NEW BALLAS RD
SAINT LOUIS MO
63141-6713
US

IV. Provider business mailing address

641 N NEW BALLAS RD
SAINT LOUIS MO
63141-6713
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-3345
  • Fax: 314-872-3180
Mailing address:
  • Phone: 314-872-3345
  • Fax: 314-872-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number2000151556
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: