Healthcare Provider Details

I. General information

NPI: 1477723799
Provider Name (Legal Business Name): CHARLES ROBERT NATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N NEW BALLAS CT SUITE 300
SAINT LOUIS MO
63141-7134
US

IV. Provider business mailing address

17300 N. OUTER 40 RD SUITE 300
CHESTERFIELD MO
63005
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0130
  • Fax: 314-569-3674
Mailing address:
  • Phone: 636-530-6161
  • Fax: 636-777-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD110027
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: