Provider Demographics
NPI:1649219569
Name:MUCKERMAN, RICHARD CHRISTOPHER II (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHRISTOPHER
Last Name:MUCKERMAN
Suffix:II
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 1:16216 BAXTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4770
Mailing Address - Country:US
Mailing Address - Phone:636-449-4700
Mailing Address - Fax:636-449-2596
Practice Address - Street 1:16216 BAXTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4770
Practice Address - Country:US
Practice Address - Phone:636-449-4700
Practice Address - Fax:636-449-2596
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8639207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20799OtherB N D D NUMBER
AM8351443OtherD E A NUMBER
23394OtherA B O G
MOR8639OtherMEDICAL LICENSE, PHY&SURG
MO20799OtherB N D D NUMBER