Healthcare Provider Details

I. General information

NPI: 1841210275
Provider Name (Legal Business Name): CARY G STOLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD DEPT OF
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

3691 RUTGER AVE PROVIDER ENROLLMENT
ST LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 143-977-5782
  • Fax: 314-977-1628
Mailing address:
  • Phone: 314-977-5782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberR7E56
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberR7E56
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR7E56
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: