Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2017033337 | MO |
N | 208600000X | Surgeon | 2017033337 | MO |
Y | 2086S0120X | Pediatric Surgery | 2017033337 | MO |
NPI | 1285865527 |
---|---|
Provider Name | Dr. Baddr Ahed Shakhsheer |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200061777 | (05) | MO |