Individual
DR. KYLE ANTHONY O'BLANC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1825 HIGH OAK RD, SAINT LOUIS, MO 63131-1501
(504) 710-8234
Mailing address
1825 HIGH OAK RD, SAINT LOUIS, MO 63131-1501
(504) 710-8234
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2018014429
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200062980
—
MO
05
—
ENROLLED
—
IL
Enumeration date
07/16/2007
Last updated
11/15/2021
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