Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2015017286 | MO |
Y | 208600000X | Surgeon | 2015017286 | MO |
NPI | 1013398965 |
---|---|
Provider Name | Cathleen Courtney |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 16/06/2015 |