Healthcare Provider Details

I. General information

NPI: 1912352931
Provider Name (Legal Business Name): GEORGE VIEWEG THIEROFF III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1101 E MARSHALL ST # 980663
RICHMOND VA
23298-5008
US

V. Phone/Fax

Practice location:
  • Phone: 314-633-7365
  • Fax:
Mailing address:
  • Phone: 804-828-9357
  • Fax: 804-828-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number2025040384
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025040384
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2025040384
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: