Provider Demographics
NPI:1023036464
Name:DEFER, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:DEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-5060
Mailing Address - Fax:314-362-6959
Practice Address - Street 1:4950 CHILDRENS PL
Practice Address - Street 2:DEPT INTERNAL MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1000
Practice Address - Country:US
Practice Address - Phone:314-362-5060
Practice Address - Fax:314-362-6959
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4N34207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203721238Medicaid
MO832510183Medicare PIN
MO832510183Medicaid
IL$$$$$$$$$Medicaid