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NPI Code Detail

MEDICARE: DR. DANIEL JEREMY WILLIGER PH.D.

MEDICARE:  DR. DANIEL JEREMY WILLIGER  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist01435MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA2526OTHERMOMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013011634
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL JEREMY WILLIGER PH.D.
Provider Business Mailing Address
First Line : 10820 SUNSET OFFICE DR 210
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63127-1030
Country : US
Telephone Number : 314-712-0365
Fax Number : 314-549-8807
Provider Business Practice Location Address
First Line : 10820 SUNSET OFFICE DR 210
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63127-1030
Country : US
Telephone Number : 314-712-0365
Fax Number : 314-549-8807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 11/30/2015

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