Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | R6C45 | MO |
NPI | 1144314485 |
---|---|
Provider Name | Dr. Mark Mintun |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 10/08/2010 |