Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD37050 | SC |
N | 111NI0900X | Internist | MD37050 | SC |
Y | 207RA0201X | Internist - Allergy & Immunology | 2018010783 | MO |
N | 208000000X | Pediatrician | MD37050 | SC |
NPI | 1841604550 |
---|---|
Provider Name | Dr. Dennis Ryan Paulk |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2014 |
Last Update Date | 12/10/2019 |