Basic Information
Provider Information
NPI: 1033558192
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CULLINAN
FirstName: DARREN
MiddleName: ROBERT
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1635 WASHINGTON AVE
Address2: UNIT 207
City: SAINT LOUIS
State: MO
PostalCode: 631031825
CountryCode: US
TelephoneNumber: 5155715089
FaxNumber:  
Practice Location
Address1: 4921 PARKVIEW PL
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631101032
CountryCode: US
TelephoneNumber: 5155715089
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/21/2013
LastUpdateDate: 06/21/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X2013020055MOY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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