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General NPI Number Information
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NPI Number | 1730106725
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Entity Type | Organization
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Legal Business Name | STL PLASTIC AND HAND SURGERY, INC.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 12855 N 40 DR NORTH TOWER SUITE 380
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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 | 314-434-7784
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Fax |
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR NORTH TOWER SUITE 380
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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 | 314-434-3603
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Fax | 314-434-3603
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Authorized Official
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Title or Position | MANAGING EMPLOYEE/OWNER
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Name | DR. ROBERT HAGAN
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Credential | MD
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Telephone | 314-434-7784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2002014802
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License Number State | MO
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