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Organization
ST. LOUIS BREAST CENTER LLC
Active
Organization
ST. LOUIS BREAST CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD MUCKERMAN III M.D. (PRESIDENT)
(314) 409-2108
Entity
Organization
Contact information
Practice address
884 WOODS MILL RD, SUITE 203, BALLWIN, MO 63011-3657
(636) 779-8008
Mailing address
884 WOODS MILL RD, SUITE 203, BALLWIN, MO 63011-3657
(636) 779-8008
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
—
MO
Other
Enumeration date
11/29/2010
Last updated
11/29/2010
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