Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Gautam Datta, MD

Individual provider Psychiatry Physician · NPI 1568688414

Dr. Gautam Datta, MD is a Psychiatry in Saint Louis, Missouri. Qualified in 2002, 24 years ago. Practices with SSM Health Care Group, a 923-clinician group. Licensed in Missouri and Ohio.

Years since qualifying
24
Licensed in
MO, OH
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

763 S New Ballas Rd Ste 110
Saint Louis, MO 63141-8704
Phone: (314) 843-4333
Fax: (314) 843-4856
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 2007008850 (MO)
Psychiatry Physician Taxonomy 2084P0800X · Licence 35087615 (OH)

Record details

NPI number1568688414
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 18, 2007
Last updated in NPPESOctober 3, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Ssm Health Care Group — 923 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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