Provider Demographics
NPI:1477562965
Name:ST LOUIS HEMATOLOGY ONCOLOGY SPECIALISTS
Entity Type:Organization
Organization Name:ST LOUIS HEMATOLOGY ONCOLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-645-3370
Mailing Address - Street 1:6400 CLAYTON RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1850
Mailing Address - Country:US
Mailing Address - Phone:314-645-3370
Mailing Address - Fax:314-645-0576
Practice Address - Street 1:6400 CLAYTON RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1850
Practice Address - Country:US
Practice Address - Phone:314-645-3370
Practice Address - Fax:314-645-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8B76207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCS2438OtherRAILROAD MEDICARE
MO117296OtherBLUE CROSS BLUE SHIELD
MOCS2438OtherRAILROAD MEDICARE