Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2019022456 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 2019022456 | MO |
NPI | 1073964722 |
---|---|
Provider Name | Dr. Alexa Michelle Altman Doss |
First Address | Saint Louis, MO 63110-1002 |
Second Address | St. Louis, MO 63110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 10/12/2020 |