Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 100685 | MO |
NPI | 1083656748 |
---|---|
Provider Name | Barbara G. Chilton |
First Address | Saint Louis, MO 63150-4944 |
Second Address | Carthage, MO 64836-3178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 19/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100166030B | (05) | OK |
100236740B | (05) | KS |
C51240 | (02) |