Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2012033710 | MO |
NPI | 1063568640 |
---|---|
Provider Name | Christian Verry |
First Address | Saint Louis, MO 63117-1508 |
Second Address | Saint Louis, MO 63141-6322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 25/09/2018 |