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NPI Code Detail

MEDICARE: DR. DAVID JOEL PERNIKOFF M.D.

MEDICARE: DR. DAVID JOEL PERNIKOFF M.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
1207R00000XInternal Medicine Physician36099MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205820594
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID JOEL PERNIKOFF M.D.
Provider Business Mailing Address
First Line : 2865 NETHERTON DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-4674
Country : US
Telephone Number : 314-653-1600
Fax Number : 314-355-5716
Provider Business Practice Location Address
First Line : 2865 NETHERTON DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-4674
Country : US
Telephone Number : 314-653-1600
Fax Number : 314-355-5716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 05/02/2011

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