Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 015204 | MO |
NPI | 1003211137 |
---|---|
Provider Name | Dr. Timothy Maher |
First Address | Saint Louis, MO 63127-1019 |
Second Address | Saint Louis, MO 63127-1019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |