Provider Demographics
NPI:1225144645
Name:PEPPER, EDWARD T (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:PEPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2344 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2909
Mailing Address - Country:US
Mailing Address - Phone:314-647-2344
Mailing Address - Fax:314-647-5108
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:STE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1223
Practice Address - Country:US
Practice Address - Phone:314-727-0012
Practice Address - Fax:314-727-0014
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO305712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
117581OtherHEALTHLINK
27716OtherGROUP HEALTH PLAN
P00185840OtherRAILROAD MEDICARE
1603421OtherMEDICARE COMPLETE
194361OtherBLUE SHIELD OF MISSOURI
3848OtherCMR
1603421OtherUHC
A12773OtherMERCY
3848OtherCMR