Individual
RUTH CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6420 CLAYTON RD, SAINT LOUIS, MO 63117-1811
(314) 768-8000
(314) 768-8011
Mailing address
1836 LACKLAND HILL PKWY, ATTN: CREDENTIALING, SAINT LOUIS, MO 63146-3572
(314) 989-0300
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036060005
IL
207P00000X
Emergency Medicine Physician
Primary
R9305
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093754715
—
MO
Enumeration date
06/06/2006
Last updated
05/26/2009
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