Healthcare Provider Details

I. General information

NPI: 1053429779
Provider Name (Legal Business Name): PERRY KENT GEISTLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12152 TESSON FERRY RD
SAINT LOUIS MO
63128-1779
US

IV. Provider business mailing address

12152 TESSON FERRY RD
SAINT LOUIS MO
63128-1779
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-7600
  • Fax: 314-842-0106
Mailing address:
  • Phone: 314-849-7600
  • Fax: 314-842-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000612
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: