Provider Demographics
NPI:1184679961
Name:WASSERSTROM, SCOTT P (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:WASSERSTROM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7412035
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2035
Mailing Address - Country:US
Mailing Address - Phone:314-367-3113
Mailing Address - Fax:314-454-9382
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:STE 375
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1392
Practice Address - Country:US
Practice Address - Phone:314-367-3113
Practice Address - Fax:314-454-9382
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-04-18
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Provider Licenses
StateLicense IDTaxonomies
MO108667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209809714Medicaid