NPI 1124496336

William Cole, DESIGNATEDMANAGER

Practitioner Preferred Provider Organization Saint Louis, MO

Practice location

Address: 1451 Mullanphy St, Saint Louis, MO 63106-3114
Phone: (314) 409-1686

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

Other Preferred Provider Organization providers in Missouri →

Registry record

NPI: 1124496336
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Sep 2015
Record last updated: 3 Sep 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.