Provider Demographics
NPI:1720086036
Name:MELTZ, GARY J (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:MELTZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:201 BJC SAINT PETERS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3091
Mailing Address - Country:US
Mailing Address - Phone:636-916-8200
Mailing Address - Fax:636-926-3303
Practice Address - Street 1:201 BJC SAINT PETERS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3091
Practice Address - Country:US
Practice Address - Phone:636-916-8200
Practice Address - Fax:636-926-3303
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2014-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201259520Medicaid
MO201259520Medicaid
A12000Medicare UPIN