Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 13708 | MO |
NPI | 1164565958 |
---|---|
Provider Name | Dr. Joseph Frederick Shea |
First Address | Saint Louis, MO 63127-1015 |
Second Address | Saint Louis, MO 63127-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |