Organization
PHYSICIAN GROUPS LC
Active
Other names
Sunset Hills Adult Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND P DAVIDSON II MD (PRESIDENT)
(314) 286-2028
Entity
Organization
Contact information
Practice address
3844 S LINDBERGH BLVD, SAINT LOUIS, MO 63127-1368
(314) 525-0490
(314) 525-0508
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7644
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD3309
MEDICARE RAILROAD
MO
Enumeration date
11/28/2006
Last updated
04/02/2008
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