Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 036.130265 | IL |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2010019783 | MO |
NPI | 1639436330 |
---|---|
Provider Name | Dr. Christopher S Ngo |
First Address | Wildwood, MO 63040-1177 |
Second Address | Wildwood, MO 63040-1177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 29/06/2021 |