Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 2009010644 | MO |
NPI | 1063618379 |
---|---|
Provider Name | Dr. Stephanie Jean Becker-Koepke |
First Address | Saint Louis, MO 63195-5534 |
Second Address | Fenton, MO 63026-0562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2007 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2009010644 | PHYSICIAN LICENSE (01) | MO |