Organization
PHYSICIAN GROUPS LC
Active
Other names
Barnes West Medical Consultants
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND P DAVIDSON II MD (PRESIDENT)
(314) 286-2028
Entity
Organization
Contact information
Practice address
969 N MASON RD, SUITE 160, CREVE COEUR, MO 63141-6338
(314) 434-8828
(314) 434-3465
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7644
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN1994
MEDICARE RAILROAD
—
Enumeration date
11/28/2006
Last updated
03/26/2008
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