Basic Information
| Provider Information | |||||||||
| NPI: | 1063568640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERRY | ||||||||
| FirstName: | CHRISTIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 CLAYTONIA TER | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146506442 | ||||||||
| FaxNumber: | 3149779627 | ||||||||
| Practice Location | |||||||||
| Address1: | 12680 OLIVE BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142518888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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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 | 207QS0010X | 2012033710 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.