Individual
DR. GAUTAM DATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
763 S NEW BALLAS RD, SUITE 110, SAINT LOUIS, MO 63141-8704
(314) 843-4333
(314) 843-4856
Mailing address
5000 CEDAR PLAZA PKWY, SUITE 350, SAINT LOUIS, MO 63128-3854
(314) 843-4333
(314) 843-4856
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2007008850
MO
2084P0800X
Psychiatry Physician
35087615
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209908706
—
MO
Enumeration date
04/18/2007
Last updated
10/03/2012
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