Garry Martin Vickar, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

R5051 Issued in MO

Practice address

11125 Dunn Road
Suite 213
St Louis, MO 63136-6132

Phone

(314) 837-4900

Fax

(314) 837-5646

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1366402612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11125 DUNN ROAD",
            "address_2": "SUITE 213",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-837-4900",
            "fax_number": "314-837-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11125 DUNN ROAD",
            "address_2": "SUITE 213",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631366132",
            "telephone_number": "314-837-4900",
            "fax_number": "314-837-5646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKAR",
        "first_name": "GARRY",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "R5051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200794402",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vibrant ABA Mo LLC
• Vibrant Health Family Medicine
• Vibrant Living Chiropractic PC
• Christina Vicari
• Norman James Vick
• Austen Vickery
• Joel Gibbons Vickery
• Angela Marie Vickroy, ANP
• Casey Vickstrom, MD, PHD
• Victor J Whittier Sr LLC

• Psychiatry Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.