Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 2019035283 | MO |
NPI | 1528447125 |
---|---|
Provider Name | Dr. Kristin Colleen Smith |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2015 |
Last Update Date | 25/03/2021 |