Healthcare Provider Details

I. General information

NPI: 1366767766
Provider Name (Legal Business Name): JOSHUA M SAPPINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/11/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S. GRAND DOOR 3
ST. LOUIS MO
63104
US

IV. Provider business mailing address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-5110
  • Fax: 314-977-7686
Mailing address:
  • Phone: 314-977-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberTEMPORARY LICENSURE
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: