Organization
GEROMED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY THIEN TANG M. D. (OWNER)
(314) 752-8600
Entity
Organization
Contact information
Practice address
4675 S GRAND BLVD, SAINT LOUIS, MO 63111-1462
(314) 752-8600
(314) 752-8601
Mailing address
4675 S GRAND BLVD, SAINT LOUIS, MO 63111-1462
(314) 752-8600
(314) 752-8601
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023026804
PROVIDER NPI
—
01
—
1417040114
PROVIDER NPI
—
05
—
208393702
—
MO
05
—
208442400
—
MO
05
—
508753001
—
MO
Enumeration date
03/09/2007
Last updated
05/27/2008
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