Provider Demographics
NPI:1922126788
Name:GERALD SHATZ, M. D.
Entity Type:Organization
Organization Name:GERALD SHATZ, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:314-741-8200
Mailing Address - Street 1:11155 DUNN RD
Mailing Address - Street 2:SUITE 111 NORTH
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6150
Mailing Address - Country:US
Mailing Address - Phone:314-741-8200
Mailing Address - Fax:314-741-2838
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:SUITE 111 NORTH
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-741-8200
Practice Address - Fax:314-741-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8059207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOAO9786Medicare UPIN