Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | R9E12 | MO |
NPI | 1013916121 |
---|---|
Provider Name | Dr. John W. Kilgore |
First Address | Saint Louis, MO 63141-8666 |
Second Address | Saint Louis, MO 63117-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 05/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202263620 | (05) | MO |
202263638 | (05) | MO |
A10226 | (02) | MO |