Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2012026129 | MO |
Y | 2080P0202X | Pediatric Cardiologist | 2012026129 | MO |
N | 2086S0120X | Pediatric Surgery | 2012026129 | MO |
NPI | 1265662241 |
---|---|
Provider Name | Dr. Toby A Rockefeller |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 27/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IL |