Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | R8H97 | MO |
NPI | 1114981933 |
---|---|
Provider Name | Gary L. Dreyer |
First Address | Saint Louis, MO 63141-8232 |
Second Address | Saint Louis, MO 63141-8221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E96782 | (02) | MO |