Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | R5G78 | MO |
NPI | 1730170507 |
---|---|
Provider Name | Frank Simo |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63141-6886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E56586 | (02) | MO |