Healthcare Provider Details

I. General information

NPI: 1881875961
Provider Name (Legal Business Name): JOHN MATTHEW CONOYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2007
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 EXECUTIVE CENTRE PARKWAY
ST. PETERS MO
63376
US

IV. Provider business mailing address

4790 EXECUTIVE CENTRE PARKWAY
ST. PETERS MO
63376
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-3100
  • Fax: 636-441-6784
Mailing address:
  • Phone: 636-441-3100
  • Fax: 636-441-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number40321
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number40321
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number40321
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number40321
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2008007439
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number2008007439
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number2008007439
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: