Individual
CHARLES R CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6000
Mailing address
339 CONSORT DR, BALLWIN, MO 63011-4439
(636) 386-9224
(636) 386-7679
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R2P09
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100195170A
—
OK
05
—
1568438307
—
MO
05
—
202311003
—
AR
05
—
243037579
—
MO
01
—
P00199788
RR MEDICARE
—
Enumeration date
02/23/2006
Last updated
12/22/2020
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