Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 103133 | MO |
N | 207PP0204X | Pediatric Emergency Physician | 103133 | MO |
NPI | 1790731545 |
---|---|
Provider Name | Angela M Holbrook |
First Address | Saint Louis, MO 63146-3572 |
Second Address | Warrenton, MO 63383-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1790731545 | (05) | MO |