Organization
ST LOUIS GASTROENTEROLOGY CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY T BRADY MD (PRESIDENT)
(314) 543-5200
Entity
Organization
Contact information
Practice address
10012 KENNERLY RD, ST LOUIS, MO 63128
(314) 543-5200
(314) 543-5219
Mailing address
10012 KENNERLY RD, SUITE 101, ST LOUIS, MO 63128
(314) 543-5200
(314) 543-5219
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502449705
—
MO
Enumeration date
01/03/2007
Last updated
11/17/2009
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