Provider Demographics
NPI:1114994878
Name:OBSTETRICS AND GYNECOLOGY, INC
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:BALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-567-5016
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 4005
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-567-5016
Mailing Address - Fax:314-567-1846
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 4005
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-567-5016
Practice Address - Fax:314-567-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9559OtherHEALTHCARE USA
MO3252OtherGROUP HEALTH PLAN