Individual
DAVID B FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12700 SOUTHFORK RD, STE 270, SAINT LOUIS, MO 63128-3201
(314) 543-5284
(314) 543-5276
Mailing address
12700 SOUTHFORK RD, STE 270, SAINT LOUIS, MO 63128-3201
(314) 543-5284
(314) 543-5276
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
104219
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003011602
MEDICARE
MO
01
—
0907145
UNITED HEALTHCARE
MO
01
—
17983
BLUE CROSS BLUE SHIELD
MO
01
—
200022602
MEDICARE RAILROAD
MO
01
—
222596
HEALTHLINK
MO
01
—
339440
GROUP HEALTH PLAN
MO
01
—
951589
AETNA
MO
Enumeration date
05/19/2006
Last updated
03/14/2017
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