Individual
DAVID C AUTRY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6800 STATE ROUTE 162, ANDERSON HOSPITAL DEPT OF RADIOLOGY, MARYVILLE, IL 62062-1000
(618) 288-5711
Mailing address
PO BOX 790051, MARYVILLE RADIOLOGY GROUP LTD, ST LOUIS, MO 63179-0051
(314) 821-5600
(314) 821-2180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361050831
—
IL
01
—
103178C
MO BLUE
—
01
—
1609119
UHC
—
01
—
507530
HEALTHLINK
—
01
—
99693
GHP
—
Enumeration date
05/04/2006
Last updated
07/08/2007
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