Healthcare Provider Details

I. General information

NPI: 1780801845
Provider Name (Legal Business Name): THOMAS J BOCKERSTETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 RAVENSRIDGE RD
SAINT LOUIS MO
63119-5502
US

IV. Provider business mailing address

9 VICTORY DR
LIBERTY MO
64068-1973
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-2100
  • Fax: 314-962-1991
Mailing address:
  • Phone: 816-313-2800
  • Fax: 813-792-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number391
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: