Basic Information
| Provider Information | |||||||||
| NPI: | 1477538874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WU | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149848827 | ||||||||
| FaxNumber: | 3149840736 | ||||||||
| Practice Location | |||||||||
| Address1: | 9930 WATSON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631261845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149848827 | ||||||||
| FaxNumber: | 3149840736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 2001002823 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300122906 | 01 | TRAVELERS | OTHER | 144352 | 01 | MO | BCBS | OTHER | 2207727 | 01 | MO | CIGNA | OTHER | 431142188OSU | 01 | MERCY | OTHER | 462197 | 01 | MO | HEALTHLINK | OTHER | 205715006 | 05 | MO | MEDICAID | 283240 | 01 | MO | GHP | OTHER | 34311V3431 | 01 | MO | HEALTHCARE USA | OTHER | 08221955 | 01 | MO | BLUE SHIELD | OTHER | 08221955 | 01 | IL | ILLINOIS BLUE | OTHER | 140376000 | 01 | DEPT OF LABOR | OTHER | 000000014047 | 01 | MO | ESSENCE | OTHER | 1601306 | 01 | MO | UHC | OTHER |