Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 2012026114 | MO |
NPI | 1073740890 |
---|---|
Provider Name | Dr. Chun-Cheng Chen |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63108-1453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2009 |
Last Update Date | 24/01/2018 |