1225144645 NPI number — EDWARD T PEPPER M.D.

Table of content: EDWARD T PEPPER M.D. (NPI 1225144645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225144645 NPI number — EDWARD T PEPPER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEPPER
Provider First Name:
EDWARD
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225144645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2344 HAMPTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63139-2909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-647-2344
Provider Business Mailing Address Fax Number:
314-647-5108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 S BRENTWOOD BLVD
Provider Second Line Business Practice Location Address:
STE 280
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-727-0012
Provider Business Practice Location Address Fax Number:
314-727-0014
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  30571 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117581 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27716 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00185840 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1603421 . This is a "MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 194361 . This is a "BLUE SHIELD OF MISSOURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3848 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1603421 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: A12773 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".




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