Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | R3N95 | MO |
NPI | 1043309792 |
---|---|
Provider Name | Dr. Robert M Mcmahon |
First Address | Saint Louis, MO 63131-1863 |
Second Address | Saint Louis, MO 63131-1863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209776418 | (05) | MO |
G03622 | (02) |