Provider Demographics
NPI:1588655948
Name:OSTERHOUT, ROBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:OSTERHOUT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13523 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:314-775-2816
Mailing Address - Fax:314-775-2821
Practice Address - Street 1:6829 PARKER RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5312
Practice Address - Country:US
Practice Address - Phone:314-373-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO068253367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered