Individual
STANLEY VRIEZELAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1027 BELLEVUE AVE, SUITE 107, SAINT LOUIS, MO 63117-1851
(314) 645-3743
(314) 647-7967
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 645-3743
(314) 647-7967
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R4D79
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010041
ESSENCE
MO
01
—
0400407
UHC
MO
01
—
101286
HEALTHLINK
MO
01
—
127499
GHP
MO
01
—
25674
BCBS
MO
01
—
4032391
AETNA
MO
01
—
A13085
MERCY
MO
Enumeration date
11/16/2005
Last updated
10/01/2012
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