Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | R4521 | MO |
NPI | 1003832239 |
---|---|
Provider Name | Dr. Marcus E Raichle |
First Address | Saint Louis, MO 63156-8221 |
Second Address | Saint Louis, MO 63110-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A12152 | (02) |