Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | R8059 | MO |
NPI | 1376515569 |
---|---|
Provider Name | Gerald S Shatz |
First Address | Florissant, MO 63031-7928 |
Second Address | Florissant, MO 63031-7928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 22/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AO9786 | (02) | MO |