Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2004009985 | MO |
N | 2080N0001X | Neonatal-Perinatal Doctor | 2004009985 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 2004009985 | MO |
NPI | 1023036746 |
---|---|
Provider Name | Dr. Maryjo Hernandez-Zipfel |
First Address | Saint Louis, MO 63108-3201 |
Second Address | Saint Louis, MO 63108-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190299 | MO-BLUE SHIELD (01) | |
206177305 | (05) | MO |
I21860 | (02) |