Healthcare Provider Details

I. General information

NPI: 1396977328
Provider Name (Legal Business Name): GREGORY B AUFFENBERG M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2009
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 350
SAINT LOUIS MO
63141-8669
US

IV. Provider business mailing address

12855 N 40 DR STE 375
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-6071
  • Fax: 314-453-9965
Mailing address:
  • Phone: 314-567-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036132771
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2021039448
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: