Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2018012226 | MO |
N | 208600000X | Surgeon | 2018012226 | MO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2018012226 | MO |
NPI | 1134428758 |
---|---|
Provider Name | Dr. Mitchell Andrew Pet |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200053721 | (05) | MO |