Provider Demographics
NPI:1902824634
Name:HART, WILLIAM M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:HART
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3937
Mailing Address - Fax:314-747-5375
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:12TH FLOOR SUITE C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3937
Practice Address - Fax:314-747-5375
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-01-16
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Provider Licenses
StateLicense IDTaxonomies
MOR5245207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0230170141Medicaid
MO200427714Medicaid
IL0230170141Medicaid
MO200427714Medicaid