Healthcare Provider Details

I. General information

NPI: 1063195923
Provider Name (Legal Business Name): MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 WATSON RD
SAINT LOUIS MO
63127-1105
US

IV. Provider business mailing address

901 W COMMERCIAL ST
KENNETT MO
63857-1100
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-6033
  • Fax:
Mailing address:
  • Phone: 573-695-2181
  • Fax: 573-695-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: ABDULLAH ARSHAD
Title or Position: MD
Credential: MD
Phone: 573-724-0083