Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2014040548 | MO |
N | 111NI0900X | Internist | 2014040548 | MO |
Y | 207RN0300X | Nephrologist | 2014040548 | MO |
NPI | 1043500259 |
---|---|
Provider Name | Dr. Andrew Francis Malone |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2011 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200021332 | (05) | MO |