Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2011018389 | MO |
Y | 2080P0203X | Pediatric Critical Care Doctor | 2011018389 | MO |
NPI | 1205805678 |
---|---|
Provider Name | Dr. Philip Charles Spinella |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 29/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205805678 | (05) | MO |
ENROLLED | (05) | IL |