Individual
DR. GRANT WATSON GERDELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3635 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 577-8780
(314) 577-8516
Mailing address
3635 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 577-8780
(314) 577-8516
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036.143211
IL
207P00000X
Emergency Medicine Physician
2012023082
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/09/2012
Last updated
07/25/2017
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