Provider Demographics
NPI:1437120060
Name:ST LOUIS FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:ST LOUIS FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-849-7600
Mailing Address - Street 1:12152 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1779
Mailing Address - Country:US
Mailing Address - Phone:314-849-7600
Mailing Address - Fax:314-842-0106
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1779
Practice Address - Country:US
Practice Address - Phone:148-497-6003
Practice Address - Fax:314-842-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016130213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014658Medicare PIN
MOV06012Medicare UPIN
MO5500280001Medicare NSC