Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 036071548 | IL |
Y | 207KA0200X | Allergist | R8A64 | MO |
NPI | 1285673715 |
---|---|
Provider Name | Jeffrey M Wright |
First Address | Saint Louis, MO 63141-6831 |
Second Address | Saint Louis, MO 63141-6831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 11/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A13270 | (02) | MO |