Provider Demographics
NPI:1235550385
Name:DOCTOR'S ON THE WAY, INC
Entity Type:Organization
Organization Name:DOCTOR'S ON THE WAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HABERSTROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-753-1529
Mailing Address - Street 1:712 N 2ND ST
Mailing Address - Street 2:STE 310
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63102-2550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 N 2ND ST
Practice Address - Street 2:STE 310
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63102-2550
Practice Address - Country:US
Practice Address - Phone:314-753-1529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty