MEDICARE: GERALD S SHATZ 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
1	207KA0200X	Allergy Physician	R8059	MO

General Provider Information

NPI Number	:	1376515569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD S SHATZ M.D.

Provider Business Mailing Address
First Line	:	253 DUNN RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7928
Country	:	US
Telephone Number	:	314-838-3948
Fax Number	:	314-830-3593

Provider Business Practice Location Address
First Line	:	253 DUNN RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7928
Country	:	US
Telephone Number	:	314-838-3948
Fax Number	:	314-830-3593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	12/22/2008

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