Organization
ST. LOUIS CENTER FOR PREVENTIVE AND LONGEVITY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ALLAN BLIGH M.D. (MEDICAL DIRECTOR)
(314) 994-1536
Entity
Organization
Contact information
Practice address
777 S NEW BALLAS RD, SUITE 200 E, SAINT LOUIS, MO 63141-8705
(314) 994-1536
(314) 692-0241
Mailing address
777 S NEW BALLAS RD, SUITE 200 E, SAINT LOUIS, MO 63141-8705
(314) 994-1536
(314) 692-0241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
102881
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306813050
INDIVIDUAL NPI NUMBER
MO
Enumeration date
05/24/2007
Last updated
12/27/2007
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