Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | R9B01 | MO |
NPI | 1023083938 |
---|---|
Provider Name | David H Cort |
First Address | Saint Louis, MO 63131-3132 |
Second Address | Chesterfield, MO 63017-3662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 29/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202263828 | (05) | MO |
25295 | BLUECROSS BLUESHIELD MO (01) | MO |
A12350 | (02) | MO |