NPI 1104212018

Tyrell Scurlock

Practitioner Contractor Saint Louis, MO

Practice location

Address: 11960 Westline Industrial Dr 201, Saint Louis, MO 63146-3209
Phone: (314) 575-8163
Mailing address: PO Box 23331, Saint Louis, MO 63156-3331

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 2003020843 (MO)

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Registry record

NPI: 1104212018
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 Apr 2015
Record last updated: 8 Apr 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.