Organization
ST LOUIS VASECTOMY, LLC
Active
Organization
ST LOUIS VASECTOMY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYBETH DUNN (MANAGER)
(732) 598-1563
Entity
Organization
Contact information
Practice address
10345 WATSON RD, SAINT LOUIS, MO 63127-1105
(732) 598-1563
Mailing address
525 ROCKWOOD PARC CT, EUREKA, MO 63025-1157
(732) 598-1563
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005020831
LICENSE
MO
01
—
2019024767
LICENSE
MO
01
—
2019024779
LICENSE
MO
01
—
R6E96
LICENSE
MO
01
—
R9H43
LICENSE
MO
Enumeration date
10/20/2020
Last updated
10/20/2020
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