Healthcare Provider Details

I. General information

NPI: 1225016066
Provider Name (Legal Business Name): RICHARD H STILL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DOUGHERTY FERRY RD SUITE 410
SAINT LOUIS MO
63122-3325
US

IV. Provider business mailing address

2355 DOUGHERTY FERRY RD SUITE 410
SAINT LOUIS MO
63122-3325
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-4992
  • Fax: 314-966-4511
Mailing address:
  • Phone: 314-966-4992
  • Fax: 314-966-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR9826
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: