Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | R4B42 | MO |
Y | 208600000X | Surgeon | R4B42 | MO |
N | 2082S0105X | Plastic Hand Surgeon | R4B42 | MO |
NPI | 1467468520 |
---|---|
Provider Name | Dr. Brent V Stromberg |
First Address | Creve Coeur, MO 63141-9074 |
Second Address | Creve Coeur, MO 63141-7029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 22/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203062401 | (05) | MO |
B67994 | (02) | MO |