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General NPI Number Information
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NPI Number | 1053699736
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Entity Type | Organization
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Legal Business Name | MOBILE ANESTHESIOLOGISTS OF MISSOURI, LLC
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 8420 W BRYN MAWR AVE SUITE 300
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City | CHICAGO
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State | IL
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Zip | 60631-3479
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Country | US
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Telephone | 773-355-5300
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Fax | 773-714-1353
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Provider Business Mailing Address
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Address Line | 8420 W BRYN MAWR AVE SUITE 300
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City | CHICAGO
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State | IL
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Zip | 60631-3479
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Country | US
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Telephone | 773-355-5300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. ROBERT S GERSON
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Credential | MD
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Telephone | 480-276-2667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2011012170
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License Number State | MO
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