Theodoro, David A

Theodoro, David A is an individual health care provider with primary practice located at 12255 De Paul Dr North Bldg Ste 260, Bridgeton MO 63044. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Theodoro, David A can be contacted via phone (314) 647-8269.

Contact Information

Primary practice address
12255 De Paul Dr North Bldg Ste 260 Bridgeton MO 63044
Phone: (314) 647-8269
Fax: (314) 646-1700
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 118293 Missouri
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 036095641 Illinois
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 28104 Mississippi

Profile Details

NPI number 1073518577
LBN Legal business name Theodoro, David A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2005
Last updated Aug 27th, 2020 - about 5 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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Identifiers

StateTypeNumberIssuer
All States NPI 1073518577 NPPES
Illinois Other 036056372 SUBSTANCE CONTROL
Illinois MEDICAID 0360957641 SUBSTANCE CONTROL
Illinois Other 1102596 SUBSTANCE CONTROL
Illinois Other 036056372 SUBSTANCE CONTROL
Illinois Other 118293 SUBSTANCE CONTROL
Illinois MEDICAID 036095641 SUBSTANCE CONTROL

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