Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | R6P06 | MO |
NPI | 1073628871 |
---|---|
Provider Name | Dr. Matthew L German |
First Address | Chesterfield, MO 63017-3625 |
Second Address | Chesterfield, MO 63017-3625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203166715 | (05) | MO |
841682728 | TAX ID (01) | |
E90141 | (02) | |
P00294903 | RR MEDICARE (01) |