Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MO108400 | MO |
N | 207R00000X | Internist | 108400 | MO |
N | 111NI0900X | Internist | 108400 | MO |
Y | 207RH0002X | Hospice and Palliative Medicine | 108400 | MO |
NPI | 1184697013 |
---|---|
Provider Name | Jill Oberle |
First Address | Chesterfield, MO 63017-3417 |
Second Address | Chesterfield, MO 63017-3417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 28/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205177116 | (05) | MO |
H28858 | (02) | MO |