Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12743 | MO |
Y | 213EG0000X | General Practice | 12743 | MO |
NPI | 1003936642 |
---|---|
Provider Name | Dr. H John Scanlon |
First Address | Saint Peters, MO 63303-6354 |
Second Address | Florissant, MO 63033-5858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 12/09/2013 |