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General NPI Number Information
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NPI Number | 1760408983
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Entity Type | Individual
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Provider Name | IRA JOE KODNER MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 1040 N MASON RD STE 120
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6399
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Country | US
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Telephone | 314-454-7177
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Fax | 314-454-5249
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE C B 8109
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 314-454-7177
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Fax | 314-747-4871
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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 | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 31243
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License Number State | MO
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