Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2006001587 | MO |
NPI | 1003254491 |
---|---|
Provider Name | Dr. David Frey Mendelson |
First Address | Saint Louis, MO 63105-3824 |
Second Address | Saint Louis, MO 63105-3824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2013 |
Last Update Date | 07/06/2013 |