Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R8H30 | MO |
N | 111NI0900X | Internist | R8H30 | MO |
Y | 207RH0002X | Hospice and Palliative Medicine | R8H30 | MO |
N | 208D00000X | General Practice Physician | R8H30 | MO |
NPI | 1043229974 |
---|---|
Provider Name | Dr. Erin L Bakanas |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202816930 | (05) | MO |
E48221 | (02) |