Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 2004004167 | MO |
NPI | 1306811179 |
---|---|
Provider Name | Dr. Laxmeesh D Nayak |
First Address | Saint Louis, MO 63131-2734 |
Second Address | Saint Louis, MO 63131-2734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 12/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86872 | (02) | MO |