Provider Demographics
NPI:1689611840
Name:ANDRUS, CHARLES HIRAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HIRAM
Last Name:ANDRUS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1008 S SPRING AVE STE 1409
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:314-977-4740
Mailing Address - Fax:314-268-5194
Practice Address - Street 1:1225 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-977-4440
Practice Address - Fax:314-977-1877
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8A852086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA12496Medicare UPIN