Organization
BOONSLICK MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT B CUSWORTH MD (PRESIDENT, BOONSLICK MED.GROUP INC)
(636) 916-8228
Entity
Organization
Contact information
Practice address
201 BJC SAINT PETERS DR, SUITE 100, SAINT PETERS, MO 63376-3091
(636) 916-8228
(636) 946-5774
Mailing address
201 BJC SAINT PETERS DR, SUITE 100, SAINT PETERS, MO 63376-3091
(636) 916-8228
(636) 946-5774
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
MO
207R00000X
Internal Medicine Physician
Primary
430954457
MO
207RG0100X
Gastroenterology Physician
—
MO
207V00000X
Obstetrics & Gynecology Physician
—
MO
Other
Enumeration date
07/11/2005
Last updated
07/21/2022
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