Provider Demographics
NPI:1861474785
Name:WEPPRICH, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:WEPPRICH
Suffix:
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: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:636-561-4100
Mailing Address - Fax:636-561-8445
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1379
Practice Address - Country:US
Practice Address - Phone:636-561-4100
Practice Address - Fax:636-561-8445
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1D85207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105929OtherBCBS
0400583OtherUHC MEDICARE COMPLETE
MO202392510Medicaid
MO101349OtherHEALTHLINK
MO127500OtherGHP
MOA10490OtherMERCY
MO4398418OtherAETNA
MO0400699OtherUHC
MO000000010042OtherESSENCE
MO110148770Medicare PIN
MO202392510Medicaid
0400583OtherUHC MEDICARE COMPLETE