Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2004030604 | MO |
NPI | 1033138243 |
---|---|
Provider Name | Aki Puryear |
First Address | St Louis, MO 63110 |
Second Address | St Louis, MO 63110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 11/03/2021 |