Fagen, Timothy D

Fagen, Timothy D is an individual health care provider with primary practice located at 1402 S Grand Blvd Ste M260 St Louis University Gme, Saint Louis MO 63104-1004. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is his primary health care specialty. Fagen, Timothy D can be contacted via phone (314) 577-8782.

Contact Information

Primary practice address
1402 S Grand Blvd Ste M260 St Louis University Gme Saint Louis MO 63104-1004
Phone: (314) 577-8782
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 5101017047 Michigan
Allopathic & Osteopathic Physicians / General Practice 208D00000X DOS 1120 Hawaii
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 2010014000 Missouri

Profile Details

NPI number 1750315958
LBN Legal business name Fagen, Timothy D
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Aug 11th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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