Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R8F00 | MO |
Y | 2080P0204X | Pediatric Emergency Doctor | R8F00 | MO |
NPI | 1295824811 |
---|---|
Provider Name | Dr. Albert K Nakanishi |
First Address | Saint Louis, MO 63110-2515 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A13378 | (02) | MO |