Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 36756 | MO |
NPI | 1154373124 |
---|---|
Provider Name | Dr. Edward W. Heidbrier |
First Address | Saint Louis, MO 63117-1850 |
Second Address | Saint Louis, MO 63117-1850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 29/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E64413 | (02) | MO |