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General NPI Number Information
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NPI Number | 1811200983
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Entity Type | Organization
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Legal Business Name | ST LOUIS NEUROLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 12810 TESSON FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2913
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Country | US
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Telephone | 314-849-5665
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Fax | 314-849-0274
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Provider Business Mailing Address
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Address Line | PO BOX 4340
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City | SAINT LOUIS
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State | MO
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Zip | 63123-0140
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Country | US
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Telephone | 314-849-5665
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Fax | 314-849-0274
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN J O'KEEFE III
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Credential | M.D.
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Telephone | 314-849-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | R7491
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License Number State | MO
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