St Louis County Otolaryngology LTD

Primary specialty

SpecialistTaxonomy code 174400000X

License

32656 Issued in MO

Legal business name

ST LOUIS COUNTY OTOLARYNGOLOGY LTD

Practice address

12255 De Paul Dr Ste 160
Bridgeton, MO 63044-2513

Phone

(314) 291-8787

Fax

(314) 291-5804

NPI assigned

Sep 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gerald William Moritz, MD

Title

Physician/Surgeon

Phone

(314) 291-8787

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881795219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-8787",
            "fax_number": "314-291-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR STE 160",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442513",
            "telephone_number": "314-291-8787",
            "fax_number": "314-291-5804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS COUNTY OTOLARYNGOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORITZ",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PHYSICIAN/SURGEON",
        "authorized_official_telephone_number": "314-291-8787",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "32656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Matthew W Stadnyk, MD

• Specialist in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.