Provider Demographics
NPI:1801099841
Name:SURGERY SPECIALIST OF ST. LOUIS
Entity type:Organization
Organization Name:SURGERY SPECIALIST OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYSARZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-5150
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1854
Mailing Address - Country:US
Mailing Address - Phone:314-644-5150
Mailing Address - Fax:314-644-5156
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-644-5150
Practice Address - Fax:314-644-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD1195842086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG65935Medicare UPIN