Provider Demographics
NPI:1841651890
Name:NEUROLOGY & SLEEP MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:NEUROLOGY & SLEEP MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-729-7547
Mailing Address - Street 1:11188 TESSON FERRY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6962
Mailing Address - Country:US
Mailing Address - Phone:314-729-7547
Mailing Address - Fax:314-729-7550
Practice Address - Street 1:11188 TESSON FERRY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6962
Practice Address - Country:US
Practice Address - Phone:314-729-7547
Practice Address - Fax:314-729-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty