Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | R6H14 | MO |
N | 207NS0135X | Procedural Dermatology | R6H14 | MO |
NPI | 1013912906 |
---|---|
Provider Name | Dr. George J. Hruza |
First Address | Chesterfield, MO 63017-2041 |
Second Address | Chesterfield, MO 63017-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A12255 | (02) | MO |