Healthcare Provider Details

I. General information

NPI: 1801359047
Provider Name (Legal Business Name): JAMES RICHARD WATLINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 406
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 406
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1224
  • Fax:
Mailing address:
  • Phone: 314-525-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2025016553
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: