Provider Demographics
NPI:1093037038
Name:STEPHEN R CRESPIN INC
Entity Type:Organization
Organization Name:STEPHEN R CRESPIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:CRESPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-1128
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 214 EAST
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-432-1128
Mailing Address - Fax:314-432-1853
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 214 EAST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-432-1128
Practice Address - Fax:314-432-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3994207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200846707Medicaid
A10815Medicare UPIN
MO000003636Medicare PIN