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General NPI Number Information
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NPI Number | 1396977328
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Entity Type | Individual
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Provider Name | GREGORY B AUFFENBERG M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2009
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 12855 N 40 DR STE 350
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8669
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Country | US
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Telephone | 314-567-6071
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Fax | 314-453-9965
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR STE 375
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-567-6071
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036132771
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2021039448
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License Number State | MO
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