Organization · Type 2 NPI
Ear Nose & Throat & Plastic Surg Inc
Facial Plastic Surgery Physician · St. Louis, MO
NPI number
1104911288
Active
Practice location
2325 Dougherty Ferry Rd Ste 106
St. Louis, MO 63122-3356
Fax (314) 821-5029
Other practice locations
- 12277 Depaul Dr Ste 303, Bridgeton, MO 63044-2529 · (314) 821-5002
- 4800 Mexico Rd Ste 103, St. Peters, MO 63376-1666 · (314) 821-5002
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Facial Plastic Surgery Physician Primary | 207YS0123X | None listed |
Facial Plastic Surgery Physician: An otolaryngologist who specializes in facial plastic surgery.
2 other providers at this address
Other facial plastic surgery physician providers in St. Louis
About NPI 1104911288
Ear Nose & Throat & Plastic Surg Inc's National Provider Identifier is 1104911288, issued on Oct 4, 2006. The primary taxonomy on file is Facial Plastic Surgery Physician (207YS0123X), and the practice location is in St. Louis, MO. The record was last updated on Oct 9, 2025.