Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 102027 | MO |
N | 2086S0105X | Surgery of the Hand | 102027 | MO |
N | 2086S0122X | Plastic and Reconstructive Surgery | 102027 | MO |
NPI | 1811913130 |
---|---|
Provider Name | Dr. Susan E Mackinnon |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203098306 | (05) | MO |