Provider Demographics
NPI:1407834260
Name:STEGEMAN, DALE M (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:M
Last Name:STEGEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12847 WESTLEDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2237
Mailing Address - Country:US
Mailing Address - Phone:314-966-8086
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD
Practice Address - Street 2:STE 340
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4770
Practice Address - Country:US
Practice Address - Phone:636-537-3100
Practice Address - Fax:636-537-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36313OtherSTATE LICENSE NUMBER
MO431398206OtherTIN
MO36313OtherSTATE LICENSE NUMBER
MO431398206OtherTIN