=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720567480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D TROY CURRY MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2018
-----------------------------------------------------
Last Update Date | 08/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11477 OLDE CABIN RD STE 210
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-997-5208
-----------------------------------------------------
Fax | 636-997-5368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11477 OLDE CABIN RD STE 210
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-997-5208
-----------------------------------------------------
Fax | 636-997-5368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | D TROY CURRY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 314-997-5208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | R3M26
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------