Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | R2J74 | MO |
Y | 208000000X | Pediatrician | R2J74 | MO |
NPI | 1033130588 |
---|---|
Provider Name | Jay Noffsinger |
First Address | Saint Louis, MO 63110-2515 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 12/07/2007 |