St. Louis Center Of Preventitive & Longevity Medicine, LLC
Internal Medicine in Saint Louis, MO. Organization (NPI-2).
NPI number1407970288
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1407970288
- Entity type
- Organization (NPI-2)
- Legal business name
- St. Louis Center Of Preventitive & Longevity Medicine, LLC
- Organization subpart
- No
- Enumeration date
- Mar 19, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | MD102881 | MO | Yes |
Practice location
1034 S Brentwood BlvdSuite 1060
Saint Louis, MO 63117-1223
Phone 314-721-0666 · Fax 314-727-9612
Mailing address
1836 Lackland Hill PkwyAttn Credentialing Depat
Saint Louis, MO 63146-3572
Phone 314-989-0300
Authorized official
Richard A. Bligh
Physician
3147210666
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