| Robert D. Tague Md Pc | |
|
10004 Kennerly Rd Saint Louis MO 63128-2141 | |
| (314) 543-5969 | |
| (314) 543-5972 |
| Full Name | Robert D. Tague Md Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10004 Kennerly Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Robert D Tague (OWNER) |
| Authorized Official Contact | 3145435969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert D. Tague Md Pc 10004 Kennerly Rd Suite 186b Saint Louis MO 63128-2141 Ph: (314) 543-5969 | Robert D. Tague Md Pc 10004 Kennerly Rd Saint Louis MO 63128-2141 Ph: (314) 543-5969 |
| NPI Number | 1679760904 |
|---|---|
| Provider Enumeration Date | 10/01/2007 |
| Last Update Date | 07/02/2015 |
| Medicare PECOS PAC ID | 2860385069 |
|---|---|
| Medicare Enrollment ID | O20040203000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679760904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R8E10 (Missouri) | Primary |
| Provider Name | Robert D Tague |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588740369 PECOS PAC ID: 7719870922 Enrollment ID: I20100611000035 |
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