Individual
DR. LEONARD F FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 S KIRKWOOD RD, SUITE 100, SAINT LOUIS, MO 63122-7254
(314) 965-9980
(314) 965-1127
Mailing address
1001 S KIRKWOOD RD, SUITE 310, SAINT LOUIS, MO 63122-7254
(314) 965-9980
(314) 965-1127
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R5G47
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202362620
—
MO
Enumeration date
07/01/2005
Last updated
05/20/2016
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