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General NPI Number Information
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NPI Number | 1679570808
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Entity Type | Individual
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Provider Name | LEONARD F FAGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 1001 S KIRKWOOD RD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63122-7254
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Country | US
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Telephone | 314-965-9980
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Fax | 314-965-1127
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Provider Business Mailing Address
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Address Line | 1001 S KIRKWOOD RD SUITE 310
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City | SAINT LOUIS
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State | MO
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Zip | 63122-7254
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Country | US
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Telephone | 314-965-9980
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Fax | 314-965-1127
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | R5G47
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License Number State | MO
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