Healthcare Provider Details

I. General information

NPI: 1427996479
Provider Name (Legal Business Name): EMMA FAMOUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
SAINT LOUIS MO
63117-1811
US

IV. Provider business mailing address

13 RIDGELAWN CT
FLORISSANT MO
63031-7023
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8000
  • Fax:
Mailing address:
  • Phone: 314-874-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: