Provider Demographics
NPI:1659398113
Name:HIRSHBERG, GARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:HIRSHBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-6215
Mailing Address - Fax:314-454-2296
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6215
Practice Address - Fax:314-454-2296
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5850207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201368933Medicaid
MO050023900Medicare PIN
IL$$$$$$$$$Medicaid
KS200632960AMedicaid
MO101740067Medicare PIN
FL917779000Medicaid
KY7100145230Medicaid
AR187087001Medicaid