Provider Demographics
NPI:1952347890
Name:ALDERSON, PHILIP O (MD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:O
Last Name:ALDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1402 S GRAND BLVD
Mailing Address - Street 2:M268
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1004
Mailing Address - Country:US
Mailing Address - Phone:314-977-9801
Mailing Address - Fax:314-977-9899
Practice Address - Street 1:1402 S GRAND BLVD
Practice Address - Street 2:M268
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1004
Practice Address - Country:US
Practice Address - Phone:314-977-9801
Practice Address - Fax:314-977-9899
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-08-06
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Provider Licenses
StateLicense IDTaxonomies
NY142692-12085R0202X, 2085N0904X
MO326952085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology