1770677742 NPI number — DR. GARY LEE SATTMAN DO

Table of content: DR. GARY LEE SATTMAN DO (NPI 1770677742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770677742 NPI number — DR. GARY LEE SATTMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SATTMAN
Provider First Name:
GARY
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1770677742
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:
208 W ST LOUIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63069-1499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-271-2520
Provider Business Mailing Address Fax Number:
636-257-4304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W ST LOUIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACIFIC
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63069-1499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-271-2520
Provider Business Practice Location Address Fax Number:
636-257-4304
Provider Enumeration Date:
10/03/2006

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: 207Q00000X , with the licence number:  31197 , 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: 0100182 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46754 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5500000006559122 . This is a "DCN NATIONAL PRACTITIONER" identifier . This identifiers is of the category "OTHER".
  • Identifier: I4600 . This is a "PRINCIPAL HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104642 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25503 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4082910 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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