Provider Demographics
NPI:1881600773
Name:SIMCKES, DAVID ELAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ELAN
Last Name:SIMCKES
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 1:456 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-997-7177
Mailing Address - Fax:314-997-9142
Practice Address - Street 1:456 N NEW BALLAS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-997-7177
Practice Address - Fax:314-997-9142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF56281Medicare UPIN
MO000013358Medicare ID - Type Unspecified