Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2006007898 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2006007898 | MO |
NPI | 1003922634 |
---|---|
Provider Name | Christopher Brian Espana |
First Address | Saint Louis, MO 63156-3340 |
Second Address | Saint Louis, MO 63128-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 01/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201195401 | (05) | MO |
I57044 | (02) | MO |