Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 2018005682 | MO |
NPI | 1437563897 |
---|---|
Provider Name | Dr. Mary Margaret Mullen |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 15/11/2021 |