Basic Information
| Provider Information | |||||||||
| NPI: | 1861473241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERTL | ||||||||
| FirstName: | JAMES | ||||||||
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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: | 3148511075 | ||||||||
| FaxNumber: | 3148514477 | ||||||||
| Practice Location | |||||||||
| Address1: | 1034 S BRENTWOOD BLVD | ||||||||
| Address2: | SUITE 816 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148637766 | ||||||||
| FaxNumber: | 3148635250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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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 | 207R00000X | 30587 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2193977 | 01 | MO | AETNA US | OTHER | 0400282 | 01 | MO | UHC | OTHER | 127491 | 01 | MO | GHP | OTHER | 136657 | 01 | MO | HEALTHLINK | OTHER | 2193977 | 01 | MO | AETNA | OTHER | 5606453 | 01 | AETNA | OTHER | 000000010036 | 01 | MO | ESSENCE | OTHER | 100623 | 01 | MO | BCBS | OTHER | D83432 | 01 | MO | MERCY | OTHER |