Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 2017009602 | MO |
Y | 207RN0300X | Nephrologist | 2019042701 | MO |
NPI | 1033649819 |
---|---|
Provider Name | Dr. Taewoo Lee |
First Address | Saint Louis, MO 63110-8719 |
Second Address | Saint Louis, MO 63110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 27/04/2021 |