Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2001011445 | MO |
NPI | 1083721500 |
---|---|
Provider Name | Christian C Willingham |
First Address | Saint Louis, MO 63178-8009 |
Second Address | Kansas City, MO 64111-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29767014 | BCBS (01) | |
G84903 | (02) |