Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2021028031 | MO |
Y | 208600000X | Surgeon | 2021028031 | MO |
N | 208200000X | Surgeon | 125059670 | IL |
N | 208600000X | Surgeon | 125059670 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | 72474 | WI |
NPI | 1225392186 |
---|---|
Provider Name | Katherine Rodby |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63110-2520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 07/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1225392186 | (05) | MO |
1225392186 | (05) | WI |