Provider Demographics
NPI:1699848150
Name:DANIEL J MESHOTO DO PC
Entity Type:Organization
Organization Name:DANIEL J MESHOTO DO PC
Other - Org Name:TELEGRAPH ROAD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN - CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MESHOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-845-8888
Mailing Address - Street 1:11110 LINDBERGH BUSINESS COURT
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7810
Mailing Address - Country:US
Mailing Address - Phone:314-845-8888
Mailing Address - Fax:314-845-8833
Practice Address - Street 1:11110 LINDBERGH BUSINESS COURT
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7810
Practice Address - Country:US
Practice Address - Phone:314-845-8888
Practice Address - Fax:314-845-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO104006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG27101Medicare UPIN