Healthcare Provider Details

I. General information

NPI: 1528086931
Provider Name (Legal Business Name): ROBERT RYERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

1715 DEER TRACKS TRL SUITE 130
SAINT LOUIS MO
63131-1839
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-821-5600
  • Fax: 314-821-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number105614
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: