Individual
GARY A VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
224 S WOODS MILL RD STE 435S, CHESTERFIELD, MO 63017-3408
(314) 576-2394
(314) 590-5937
Mailing address
1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3539
(636) 669-2268
(314) 209-8127
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
108736
MO
208M00000X
Hospitalist Physician
108736
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902867633
—
IL
05
—
1902867633
—
MO
Enumeration date
03/31/2006
Last updated
01/25/2021
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