Provider Demographics
NPI:1396708954
Name:SPIELER, COLLEEN CANNON (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:CANNON
Last Name:SPIELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11475 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7128
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-991-8206
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-6031
Practice Address - Fax:314-251-6031
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1136392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208852319Medicaid
MO051010288Medicare PIN
G52912Medicare UPIN
MO208852319Medicaid