Individual
DR. RANDY S FATHEREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10 HOSPITAL DR, SAINT PETERS, MO 63376-1659
(314) 895-3828
(314) 895-3827
Mailing address
PO BOX 5, HAZELWOOD, MO 63042-0005
(314) 895-3828
(314) 895-3827
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
108473
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
244631008
—
MO
Enumeration date
10/03/2005
Last updated
03/28/2010
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