Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 014554 | MO |
NPI | 1043292451 |
---|---|
Provider Name | Dr. Gregg William Hosch |
First Address | Chesterfield, MO 63017-7954 |
Second Address | St. Louis, MO 63126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2005 |
Last Update Date | 10/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U06292 | (02) | MO |