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Contact Information

TIMOTHY D FAGEN, DO
1402 S GRAND BLVD STE M260
ST LOUIS UNIVERSITY GME
SAINT LOUIS, MO63104-1004
 Phone: 314-577-8782
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
Indicates primary specialty

NPI Profile & details for TIMOTHY D FAGEN · (Male)

NPI Number 1750315958
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/11/2006
Last updated 08/11/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • HI License # DOS 1120
  • MI License # 5101017047
  • MO License # 2010014000
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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