Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 2011012606 | MO |
Y | 208200000X | Surgeon | 2011012606 | MO |
Y | 208600000X | Surgeon | 2011012606 | MO |
NPI | 1013182120 |
---|---|
Provider Name | Dr. Dominic Emmanuel Sanford |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63136-6150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200003351 | (05) | MO |