Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | R3J23 | MO |
NPI | 1215938550 |
---|---|
Provider Name | Dr. Anthony Joseph D'angelo JR. |
First Address | St. Louis, MO 63122-4323 |
Second Address | St. Louis, MO 63122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 30/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
242700706 | (05) | MO |
E61058 | (02) | MO |