Individual
DAVID S LICKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
232 S WOODS MILL ROAD, CHESTERFIELD, MO 63017-3417
(314) 205-6990
Mailing address
232 S WOODS MILL ROAD, CHESTERFIELD, MO 63017-3417
(314) 205-6990
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R9812
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205869732
—
MO
05
—
201165511
—
MO
Enumeration date
07/08/2006
Last updated
09/03/2009
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