Healthcare Provider Details

I. General information

NPI: 1235155136
Provider Name (Legal Business Name): DAVID JOHN HINKLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE BOX 8111
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

326 CANNONBURY DR
WEBSTER GROVES MO
63119-4810
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5262
  • Fax: 314-362-3789
Mailing address:
  • Phone: 314-962-3324
  • Fax: 314-962-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2005019825
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: