Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | R8D06 | MO |
Y | 207RI0011X | Interventional Cardiology | R8D06 | MO |
NPI | 1124060975 |
---|---|
Provider Name | Dr. Kenneth Bryan Trimmer |
First Address | Saint Louis, MO 63131-2328 |
Second Address | Saint Louis, MO 63131-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
242012102 | (05) | MO |
A10566 | (02) |