Active NPI
Alfredo Custodio, M.D.
- Surgery Physician
- Saint Louis, MO
National Provider Identifier
1144427469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MDR7797
- Practice address
- 11133 Dunn Rd
Saint Louis, MO 63136-6119 - Phone
- (314) 653-5744
- Fax
- (314) 653-5613
- NPI assigned
- Jun 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MDR7797 | MO | Primary |
Addresses
Primary practice location
11133 Dunn Rd
Saint Louis, MO 63136-6119
Mailing address
11133 Dunn Rd
Saint Louis, MO 63136-6119
Phone (314) 653-5744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR7797 | MO | MD | Surgery Physician |
Interoperability endpoints
- acustodio123450@direct.carenet.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193356800000",
"number": "1144427469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11133 DUNN RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631366119",
"telephone_number": "314-653-5744",
"fax_number": "314-653-5613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11133 DUNN RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631366119",
"telephone_number": "314-653-5744",
"fax_number": "314-653-5613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTODIO",
"first_name": "ALFREDO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-29",
"last_updated": "2007-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "MDR7797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.