Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 108719 | MO |
NPI | 1487617411 |
---|---|
Provider Name | Dr. Avril Slavin |
First Address | Saint Louis, MO 63117-1811 |
Second Address | Saint Louis, MO 63117-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203720305 | (05) | MO |
A12520 | (02) | MO |