Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2008011074 | MO |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 0535651 | KS |
NPI | 1174759203 |
---|---|
Provider Name | Dr. Thomas Frederick Satterly III |
First Address | Rolla, MO 65401-2905 |
Second Address | Rolla, MO 65401-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2008011074 | LICENSE (01) | MO |