Nicanor D Devera, MD
Individual provider Active NPI Emergency Medicine Physician · Saint Louis, MO
NPI 1295853802 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295853802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- R8B11 (MO)
- Practice address
- 6150 Oakland Ave
Co Marilyn Kornberger
Saint Louis, MO 63139-3215 - Phone
- (314) 768-3090
- Fax
- (314) 768-3031
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R8B11 | MO | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forest Park Emergency Physicians LLC | Emergency Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | R8B11 | MO | Yes |
Addresses
Primary practice location
6150 Oakland Ave
Co Marilyn Kornberger
Saint Louis, MO 63139-3215
Mailing address
531 Pebble Brook LN
Hmai
Belleville, IL 62221-7609
Phone (618) 779-5508
Other providers in Saint Louis, MO
- Ramadevi Devabhaktuni
- Sai Kaushik Devana
- Devanity Health Care Services LLC
- Ruchi Devbhandari
- Developing Minds Therapy Services Inc.
- Alexis Marie Winifred Devereaux
- Devereux Chiropractic & Acupuncture LLC
- Devereux Chiropractic and Acupuncture LLC
- Scott L Devereux
- Jalpa Devi
All providers in Saint Louis, MO · Emergency Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.