Organization
MISSOURI BONE & JOINT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEO A WHITESIDE MD (PRESIDENT)
(314) 205-2223
Entity
Organization
Contact information
Practice address
1000 DES PERES RD, SUITE 120, SAINT LOUIS, MO 63131-2050
(314) 205-2223
(314) 205-2324
Mailing address
1000 DES PERES RD, SUITE 120, SAINT LOUIS, MO 63131-2050
(314) 205-2223
(314) 205-2324
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
R4328
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21967
ANTHEM BCBS
MO
01
—
411335
AETNA
MO
01
—
623004
HEALTHLINK
MO
Enumeration date
01/23/2007
Last updated
08/22/2020
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