Individual
HARRY GLYN GREDITZER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11133 DUNN ROAD, SAINT LOUIS, MO 63136
(314) 653-4300
(314) 821-2180
Mailing address
1715 DEER TRACKS TRAIL, SUITE 130, SAINT LOUIS, MO 63131
(314) 821-5600
(314) 821-2180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R7801
MO
2085R0202X
Diagnostic Radiology Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006021895
IL BLUE
—
01
—
100265
H LINK
—
01
—
1077061
MC MCAID
—
01
—
1390
MO BLUE
—
01
—
1611000
PH PLAN
—
01
—
22730
BLUE CHOICE
—
01
—
2781
GHP
—
01
—
317617
HLT PART
—
01
—
6006
HCARE USA
—
01
—
A27719
GATE WAY
—
01
—
L40182
IL CARE
—
Enumeration date
07/28/2006
Last updated
07/08/2007
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