Organization
HOUSE CALL DOCTORS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY PEVNICK DPT (CO-OWNER)
(314) 653-0918
Entity
Organization
Contact information
Practice address
2865 NETHERTON DR, SAINT LOUIS, MO 63136-4674
(314) 653-0918
Mailing address
2865 NETHERTON DR, SAINT LOUIS, MO 63136-4674
(314) 653-0918
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014757
PTAN
MO
01
—
IL6527
PTAN
IL
Enumeration date
06/11/2006
Last updated
08/25/2015
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