Provider Demographics
NPI:1164442141
Name:ESCHER, DELBERT T JR (MD)
Entity type:Individual
Prefix:
First Name:DELBERT
Middle Name:T
Last Name:ESCHER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10511 OLD OLIVE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5925
Mailing Address - Country:US
Mailing Address - Phone:314-993-2660
Mailing Address - Fax:
Practice Address - Street 1:10511 OLD OLIVE STREET RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5925
Practice Address - Country:US
Practice Address - Phone:314-993-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3M05207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207929019Medicaid
MO207929019Medicaid
MO1164442141Medicare PIN