Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2005012170 | MO |
NPI | 1003826520 |
---|---|
Provider Name | Donna R Halloran |
First Address | St. Louis, MO 63110-2515 |
Second Address | St. Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 31/07/2015 |