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General NPI Number Information
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NPI Number | 1184755118
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Entity Type | Organization
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Legal Business Name | GEROMED, LLC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 4675 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1462
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Country | US
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Telephone | 314-752-8600
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Fax | 314-752-8601
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Provider Business Mailing Address
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Address Line | 4675 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1462
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Country | US
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Telephone | 314-752-8600
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Fax | 314-752-8601
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Authorized Official
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Title or Position | OWNER
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Name | DR. TONY THIEN TANG
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Credential | M. D.
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Telephone | 314-752-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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