Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2005031267 | MO |
NPI | 1013191618 |
---|---|
Provider Name | Dr. Richard Emer Mcdermott |
First Address | Fenton, MO 63026-3052 |
Second Address | O Fallon, MO 63368-8675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |