Healthcare Provider Details

I. General information

NPI: 1801099841
Provider Name (Legal Business Name): SURGERY SPECIALIST OF ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BELLEVUE AVE SUITE 203
SAINT LOUIS MO
63117-1854
US

IV. Provider business mailing address

1035 BELLEVUE AVE SUITE 203
SAINT LOUIS MO
63117-1854
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-5150
  • Fax: 314-644-5156
Mailing address:
  • Phone: 314-644-5150
  • Fax: 314-644-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD119584
License Number StateMO

VIII. Authorized Official

Name: DR. FRANCIS A DYSARZ III
Title or Position: M.D.
Credential: M.D.
Phone: 314-644-5150