Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 2019014155 | MO |
Y | 207WX0107X | Retina Specialist | 2019014155 | MO |
NPI | 1033505086 |
---|---|
Provider Name | Dr. Alexander R Bottini |
First Address | Saint Louis, MO 63144-1870 |
Second Address | Saint Louis, MO 63117-1118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 05/02/2020 |