Individual
GREGG BANTRUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 1ST CAPITOL DR, SAINT CHARLES, MO 63301-2844
(314) 989-3000
Mailing address
13523 BARRETT PARKWAY DR, SUITE 210, BALLWIN, MO 63021-3802
(314) 775-2816
(314) 775-2821
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
108695
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208042010
—
MO
01
—
P00139813
RR MEDICARE
MO
Enumeration date
05/06/2006
Last updated
05/02/2013
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