Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | R7939 | MO |
NPI | 1043275811 |
---|---|
Provider Name | Dr. Timothy J Reichert |
First Address | Saint Louis, MO 63141-8232 |
Second Address | Saint Louis, MO 63141-8232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200454916 | (05) | MO |
A09565 | (02) | MO |