Provider Demographics
NPI:1922413715
Name:ENGEMANN, SAMUEL COOPER (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:COOPER
Last Name:ENGEMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2508
Mailing Address - Country:US
Mailing Address - Phone:636-253-5120
Mailing Address - Fax:
Practice Address - Street 1:2680 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2508
Practice Address - Country:US
Practice Address - Phone:636-253-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine