Individual
RICHARD H. ROETTGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12266 DE PAUL DR STE 305, BRIDGETON, MO 63044
(314) 770-0991
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2014006605
MO
208600000X
Surgery Physician
23291
SC
2086S0127X
Trauma Surgery Physician
Primary
2014006605
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020052517
RR MEDICARE
SC
01
—
3087952
CIGNA ID
SC
01
—
4279822
AETNA ID
SC
01
—
576007863077
BCBS OF SC ID
SC
05
—
N01002
—
SC
Enumeration date
05/15/2006
Last updated
10/26/2020
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