Provider Demographics
NPI:1235182189
Name:FALCONER, ERICK A (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:A
Last Name:FALCONER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10287 CLAYTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1172
Mailing Address - Country:US
Mailing Address - Phone:314-692-2639
Mailing Address - Fax:314-692-2649
Practice Address - Street 1:10287 CLAYTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1172
Practice Address - Country:US
Practice Address - Phone:314-692-2639
Practice Address - Fax:314-692-2649
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO115456207P00000X
IL036112484207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235182189Medicaid
MO1235182189Medicaid
MO229050091Medicare UPIN
MO1235182189Medicaid