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General NPI Number Information
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NPI Number | 1295985554
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Entity Type | Individual
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Provider Name | ROBERT HACKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 1300 HRC PLAZA DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1869
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Country | US
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Telephone | 314-755-1084
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-0209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD444137
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 252045
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35126367
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 46827
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 2019008677
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License Number State | MO
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