Organization
ST. LOUIS CENTER FOR PREVENTIVE AND LONGEVITY MEDICINE, LLC
Active
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
Update your record
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