Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2019039164 | MO |
N | 207RC0200X | Critical Care Medicine | 2019039164 | MO |
NPI | 1083077333 |
---|---|
Provider Name | Dr. Daniel Vanvalkinburgh |
First Address | Saint Louis, MO 63110-2515 |
Second Address | St. Louis, MO 63104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 27/07/2021 |