Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | R7077 | MO |
NPI | 1013978394 |
---|---|
Provider Name | Dr. Garland R Tschudin |
First Address | Saint Louis, MO 63128-4901 |
Second Address | Saint Louis, MO 63128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F21677 | (02) | MO |