Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036068207 | IL |
N | 207K00000X | Allergist & Immunologist | R8A32 | MO |
NPI | 1205908639 |
---|---|
Provider Name | Barry F Zeffren |
First Address | Glen Carbon, IL 62034 |
Second Address | Glen Carbon, IL 62034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 10/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45997 | (02) | IL |