Individual
DEBABRATA BANERJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
83 PROGRESS PKWY, MARYLAND HEIGHTS, MO 63043
(314) 434-8174
(314) 434-8706
Mailing address
83 PROGRESS PKWY, MARYLAND HEIGHTS, MO 63043-3701
(314) 434-8174
(314) 434-8706
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
R6523
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201187705
—
MO
Enumeration date
07/08/2005
Last updated
11/21/2011
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