Provider Demographics
NPI:1861473241
Name:SERTL, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SERTL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:314-851-1075
Mailing Address - Fax:314-851-4477
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 816
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1223
Practice Address - Country:US
Practice Address - Phone:314-863-7766
Practice Address - Fax:314-863-5250
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO30587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2193977OtherAETNA US
MO0400282OtherUHC
MO127491OtherGHP
MO136657OtherHEALTHLINK
MO2193977OtherAETNA
5606453OtherAETNA
MO000000010036OtherESSENCE
MO100623OtherBCBS
MOD83432OtherMERCY
MO2193977OtherAETNA US