Provider Demographics
NPI:1639150378
Name:OERTLI, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:OERTLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-849-6000
Mailing Address - Fax:314-849-1417
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2182
Practice Address - Country:US
Practice Address - Phone:314-849-6000
Practice Address - Fax:314-849-1417
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4040611OtherAETNA
MOA09919OtherMERCY
MO127470OtherGHP
MO000000010027OtherESSENCE
MO123463OtherHEALTHLINK
MO0400066OtherUHC
MO21998OtherBCBS
MO000000010027OtherESSENCE
MOA09919Medicare UPIN
MOA09919OtherMERCY