Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2010014919 | MO |
NPI | 1053516062 |
---|---|
Provider Name | Aibing Mary Guo |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 26/01/2021 |