Healthcare Provider Details

I. General information

NPI: 1477517860
Provider Name (Legal Business Name): ALAN BIRTWISTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALAN BIRTWISTLE M.D.

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

13253 ROMANY WAY CT
SAINT LOUIS MO
63131-1610
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-845-5077
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-845-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2004001430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: