Healthcare Provider Details

I. General information

NPI: 1932226107
Provider Name (Legal Business Name): ADVANCED UROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/11/2009
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

PO BOX 952853
SAINT LOUIS MO
63195-0001
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: DR. RICHARD H STILL III
Title or Position: PRESIDENT
Credential: D.O.
Phone: 314-966-4992