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General NPI Number Information
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NPI Number | 1063484400
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Entity Type | Organization
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Legal Business Name | ST LOUIS ORTHOPEDIC SURGERY, INC
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 12/09/2018
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Provider Practice Location Address
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Address Line | 2821 N BALLAS RD SUITE C-15
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2321
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Country | US
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Telephone | 314-983-0088
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Fax | 314-983-9650
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Provider Business Mailing Address
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Address Line | 2821 N BALLAS RD STE C15
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2300
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Country | US
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Telephone | 314-989-0300
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | DANIEL A SCHWARZE
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Credential | MD
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Telephone | 314-983-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | R7J25
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | R9G33
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License Number State | MO
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