Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R4155 | KY |
N | 111NI0900X | Internist | R4155 | KY |
Y | 207RA0201X | Internist - Allergy & Immunology | 2020015516 | MO |
N | 208000000X | Pediatrician | R4155 | KY |
N | 2080P0201X | Pediatric Allergist | 2020015516 | MO |
NPI | 1629430822 |
---|---|
Provider Name | Alexander Patterson |
First Address | St Louis, MO 63110 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2016 |
Last Update Date | 17/06/2020 |