Organization
MID-COUNTY UROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD D GAUM MD (OWNER PRESIDENT)
(314) 569-1750
Entity
Organization
Contact information
Practice address
621 S NEW BALLAS RD, SUITE 6011B, SAINT LOUIS, MO 63141-8232
(314) 569-1750
(314) 569-3846
Mailing address
621 S NEW BALLAS RD, SUITE 6011B, SAINT LOUIS, MO 63141-8232
(314) 569-1750
(314) 569-3846
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
103702
MO
208800000X
Urology Physician
Primary
R4A96
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201244514
—
MO
Enumeration date
05/25/2006
Last updated
10/02/2012
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