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NPI Code Detail

MEDICARE: MR. PHILIP O ALDERSON MD

MEDICARE: MR. PHILIP O ALDERSON MD
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
12085R0202XDiagnostic Radiology Physician142692-1NY
22085N0904XNuclear Radiology Physician142692-1NY
32085N0904XNuclear Radiology Physician32695MO

General Provider Information

NPI Number : 1952347890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILIP O ALDERSON MD
Provider Business Mailing Address
First Line : 1402 S GRAND BLVD
Second Line : M268
City : SAINT LOUIS
State : MO
Zip : 63104-1004
Country : US
Telephone Number : 314-977-9801
Fax Number : 314-977-9899
Provider Business Practice Location Address
First Line : 1402 S GRAND BLVD
Second Line : M268
City : SAINT LOUIS
State : MO
Zip : 63104-1004
Country : US
Telephone Number : 314-977-9801
Fax Number : 314-977-9899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 08/06/2008

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