Lisa S. Etzwiler, M.D.

Primary specialty

Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X

License

102051 Issued in MO

Practice address

621 S New Ballas Rd
St. John'S Mercy Medical Center, Suite 6006, Tower B
Creve Coeur, MO 63141-8232

Phone

(314) 251-6299

Fax

(314) 251-4450

NPI assigned

Aug 29, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740398593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16522 BAXTER FOREST RIDGE DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630054661",
            "telephone_number": "636-519-1655",
            "fax_number": "636-536-4973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD",
            "address_2": "ST. JOHN'S MERCY MEDICAL CENTER, SUITE 6006, TOWER B",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631418232",
            "telephone_number": "314-251-6299",
            "fax_number": "314-251-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETZWILER",
        "first_name": "LISA",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "MO",
            "license": "102051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Emergency Medicine (Emergency Medicine) Physician in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Pediatric Emergency Medicine (Emergency Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.