Provider Demographics
NPI:1235243858
Name:HART, WILLIAM G (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:HART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:621 SO. NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 676A
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-6250
Mailing Address - Fax:314-251-6822
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 676A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6250
Practice Address - Fax:314-251-6822
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-10-06
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Provider Licenses
StateLicense IDTaxonomies
MOR6255208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431300839OtherTAX ID
MO431300839OtherTAX ID
MO000001659Medicare ID - Type Unspecified