Provider Demographics
NPI:1316074727
Name:MECKER, ROBERT W JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:MECKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5667 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5242
Mailing Address - Country:US
Mailing Address - Phone:636-221-1155
Mailing Address - Fax:636-583-2166
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-257-5879
Practice Address - Fax:618-257-6740
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012003469207P00000X
IL036113285207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00226791OtherRAILROAD MEDICARE
ILP00226791OtherRAILROAD MEDICARE
ILK17134Medicare ID - Type Unspecified