Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 105685 | MO |
NPI | 1013934579 |
---|---|
Provider Name | Dr. Caroline M Mann |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63141-6282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205091606 | (05) | MO |