Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 2021038513 | MO |
N | 208000000X | Pediatrician | 2021038513 | MO |
NPI | 1043716210 |
---|---|
Provider Name | Dr. Ashley Heesoo Roh |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 29/11/2021 |