Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 2012023503 | MO |
NPI | 1417155383 |
---|---|
Provider Name | Colleen M. Fitzpatrick |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 26/02/2016 |