Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 114867 | MO |
Y | 2080P0210X | Pediatric Nephrologist | 114867 | MO |
NPI | 1457458879 |
---|---|
Provider Name | Craig W Belsha |
First Address | Saint Louis, MO 63104-1003 |
Second Address | St. Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/01/2021 |