Basic Information
| Provider Information | |||||||||
| NPI: | 1467871137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRALLMEIER | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1132 DUNWOODY DR | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631221716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734650251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 HOLLY HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143535190 | ||||||||
| FaxNumber: | 3143537631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2017019165 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.