# BRIDGETON GERIATRICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245652924
- **Authorized official:** DR. DAVID A SMITH MD (OWNER)
- **Authorized official phone:** (314) 551-0338

## Contact information

- **Practice address:** 12800 BOENKER LN, BRIDGETON, MO 63044-2438
- **Practice address phone:** (314) 551-0338
- **Practice address fax:** (314) 551-0336
- **Mailing address:** 12800 BOENKER LN, BRIDGETON, MO 63044-2438
- **Mailing address phone:** (314) 551-0338
- **Mailing address fax:** (314) 551-0336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 104361 | MO | Yes |

## Other

- **Enumeration date:** 01/14/2014
- **Last updated:** 01/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2083138069 | — | MO |