Provider Demographics
NPI:1205854908
Name:BIRGE, STANLEY J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:BIRGE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8031
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-2700
Mailing Address - Fax:314-747-8856
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 5C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-286-2700
Practice Address - Fax:314-286-2701
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-07-19
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Provider Licenses
StateLicense IDTaxonomies
MO29153207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200943314Medicaid
ILENROLLEDMedicaid
MO002410183Medicare PIN
MO002410183Medicaid