Doctor Name: | DR. KONRAD WIDMER |
NPI Number: | 1255359170 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 036048901 |
Business Practice Address: | 1 Coverly Ln Saint Louis, MO - 631263200 |
Business Phone Number: | 3149330151 |
Business Fax Number: | |
Mailing Address: | 1 Coverly Ln, SAINT LOUIS |
State: | MO |
Postal Code: | 631263200 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/18/2006 |
NPI Last Update Date: | 06/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036048901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |