Provider Demographics
NPI:1376547802
Name:PROPHETE, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PROPHETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YVES
Other - Middle Name:ROBERT
Other - Last Name:PROPHETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15278 COUNTRY FIELD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7345 WATSON RD
Practice Address - Street 2:SOUTHWEST MEDICAL CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4405
Practice Address - Country:US
Practice Address - Phone:314-752-7100
Practice Address - Fax:314-752-3284
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8871208800000X
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL32450/818070Medicare ID - Type UnspecifiedMEDICARE #/GROUP #