Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2016006388 | MO |
Y | 111NI0900X | Internist | 2016006388 | MO |
NPI | 1003158221 |
---|---|
Provider Name | Conor Mccartney |
First Address | Saint Louis, MO 63150-5146 |
Second Address | Fenton, MO 63026-2394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 08/10/2021 |