Organization
W DAVID KISTLER JR MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN H KISTLER (OFFICE MANAGER)
(314) 721-0411
Entity
Organization
Contact information
Practice address
950 FRANCIS PL, STE 113, SAINT LOUIS, MO 63105-2465
(314) 721-0411
(314) 721-5968
Mailing address
950 FRANCIS PL, STE 113, SAINT LOUIS, MO 63105-2465
(314) 721-0411
(314) 721-5968
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178790
ANTHEM BLUE CROSS BLUE SHIELD
MO
05
—
200690907
—
MO
01
—
817008
COVENTRY
MO
01
—
P00174135
RAILROAD MEDICARE
MO
Enumeration date
12/31/2014
Last updated
05/11/2015
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