Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 105547 | MO |
NPI | 1043271711 |
---|---|
Provider Name | Dr. John E Del Rosario |
First Address | Saint Louis, MO 63128-2786 |
Second Address | Saint Louis, MO 63128-2106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F84752 | (02) |