Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 2004001650 | MO |
NPI | 1033122676 |
---|---|
Provider Name | Dr. Jason J Li |
First Address | Saint Louis, MO 63131-2329 |
Second Address | Saint Louis, MO 63131-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 29/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H78310 | (02) | MO |