Mr. JASTIN L ANTISDEL MD
Individual Provider (NPI-1)
Active
Otolaryngology
Provider Information
- NPI Number
1073714564- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MD
- Status
- Active
Contact & Location
- Address
- 1225 S GRAND BLVD GARDEN LEVEL, SAINT LOUIS, MO, 631041016
- Phone
- (314) 977-5110
- Fax
- (314) 977-7686
Specialties & Taxonomies
Otolaryngology
License: GA #062018
Otolaryngology
Primary License: MO #2005036993