Individual
DR. ROGER V. VARDELEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
327 CONWAY LAKE DR, SAINT LOUIS, MO 63141-8114
(314) 576-4042
(314) 576-4042
Mailing address
327 CONWAY LAKE DR, SAINT LOUIS, MO 63141-8114
(314) 576-4042
(314) 576-4042
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R4094
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200138915
—
MO
Enumeration date
08/30/2006
Last updated
01/12/2012
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