Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 35815 | MO |
NPI | 1073628715 |
---|---|
Provider Name | Dr. Anne Herron |
First Address | Chesterfield, MO 63017-3625 |
Second Address | Chesterfield, MO 63017-3625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A11506 | (02) | |
P00092814 | RR MEDICARE (01) |