Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2011005789 | MO |
N | 2080P0203X | Pediatric Critical Care Doctor | 2011005789 | MO |
NPI | 1275721706 |
---|---|
Provider Name | Dr. Manuel D Silva Carmona |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 17/01/2014 |