Healthcare Provider Details

I. General information

NPI: 1508829177
Provider Name (Legal Business Name): JAMES VON BEATTIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E CHERRY ST # 300A
TROY MO
63379-1513
US

IV. Provider business mailing address

1000 E CHERRY ST # 300A
TROY MO
63379-1513
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-3382
  • Fax: 636-528-3396
Mailing address:
  • Phone: 636-528-3382
  • Fax: 636-528-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2000158289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: