Individual
DR. JOHN OLDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11133 DUNN RD, RM H2241, SAINT LOUIS, MO 63136-6119
(314) 653-5663
Mailing address
6905 WASHINGTON AVE, SAINT LOUIS, MO 63130-4309
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R9476
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659376390
—
MO
05
—
201103728
—
MO
Enumeration date
06/18/2005
Last updated
10/06/2011
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