Randall A Clary, MD
Individual provider Active NPI Pediatric Otolaryngology Physician · Saint Louis, MO
NPI 1306801600 · NPPES record last updated May 4, 2011
Key facts
- NPI
- 1306801600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Otolaryngology Physician 207YP0228X
- License
- 100674 (MO)
- Practice address
- 621 S New Ballas Rd
Ste 622a
Saint Louis, MO 63141-8232 - Phone
- (314) 872-8340
- Fax
- (314) 872-8399
- NPI assigned
- Apr 19, 2006
- 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Otolaryngology Physician | 207YP0228X | 100674 | MO | Yes |
Addresses
Primary practice location
621 S New Ballas Rd
Ste 622a
Saint Louis, MO 63141-8232
Mailing address
621 S New Ballas Rd
Ste 622a
Saint Louis, MO 63141-8232
Phone (314) 872-8340
Other providers in Saint Louis, MO
- Clarkson Optometry Inc
- Clarkson Optometry Inc
- Clarkson Optometry Inc
- Sara Nicole Clarkson
- Derek William Clary
- Claudia Gray Smiles, LLC
- Margaret Clausen Holbert
- Mary Clausen Thomas
- Susan H Clauss
- Stephanie E Clawson
All providers in Saint Louis, MO · Pediatric Otolaryngology 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 May 4, 2011. 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.