Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2004007508 | MO |
N | 2080N0001X | Neonatal-Perinatal Doctor | 2004007508 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 2004007508 | MO |
NPI | 1073531505 |
---|---|
Provider Name | Dr. Marissa Christine Stock |
First Address | Washington, MO 63090-4700 |
Second Address | Washington, MO 63090-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 23/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206232407 | (05) | MO |
I50511 | (02) |