=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750496303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN J BANDER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 06/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12909 DES PERES WOODS DR
-----------------------------------------------------
City | DES PERES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-995-7081
-----------------------------------------------------
Fax | 314-567-0802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10435 CLAYTON RD STE 200
-----------------------------------------------------
City | FRONTENAC
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-995-7081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | R5A22
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------