Individual
DR. MAX MILLER WATTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 BARNES JEWISH HOSPITAL PLZ, DIV IM MEDICAL ONCOLOGY, SAINT LOUIS, MO 63110-1003
(800) 647-2098
(314) 362-3192
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(800) 647-2098
(314) 362-3192
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2024018857
MO
207RX0202X
Medical Oncology Physician
Primary
2024018857
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200142683
—
MO
Enumeration date
03/26/2014
Last updated
04/17/2025
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