Individual
DR. TIMOTHY P REARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 GRAHAM RD, DIV IM MEDICAL ONCOLOGY, STE 101, FLORISSANT, MO 63031-8014
(800) 647-2098
(314) 362-3192
Mailing address
660 S EUCLID AVE, CB 8056, SAINT LOUIS, MO 63110-1010
(800) 647-2098
(314) 362-3192
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
R2H83
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207853003
—
MO
Enumeration date
08/04/2006
Last updated
11/15/2021
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