Provider Demographics
NPI:1154310977
Name:DRUCK, NORMAN S (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:S
Last Name:DRUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 419161
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9161
Mailing Address - Country:US
Mailing Address - Phone:314-523-5300
Mailing Address - Fax:314-434-3191
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 37 WEST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-523-5300
Practice Address - Fax:314-434-3191
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4934207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO040007606OtherRAILROAD MEDICARE
A13212Medicare UPIN
001010716Medicare ID - Type Unspecified