MEDICARE: RONALD WEPPRICH 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	207R00000X	Internal Medicine Physician	R1D85	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0400583	OTHER		UHC MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105929	OTHER	MO	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	101349	OTHER	MO	HEALTHLINK
5	127500	OTHER	MO	GHP
6	A10490	OTHER	MO	MERCY
7	4398418	OTHER	MO	AETNA
8	0400699	OTHER	MO	UHC
9	000000010042	OTHER	MO	ESSENCE

General Provider Information

NPI Number	:	1861474785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD WEPPRICH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	636-561-4100
Fax Number	:	636-561-8445

Provider Business Practice Location Address
First Line	:	200 MEDICAL PLZ
Second Line	:	SUITE 101
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1379
Country	:	US
Telephone Number	:	636-561-4100
Fax Number	:	636-561-8445

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	10/01/2012

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Directions to “ RONALD WEPPRICH M.D.” Practice Location

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