Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 31757 | MO |
N | 2084N0600X | Clinical Neurophysiologist | 31757 | MO |
NPI | 1033136619 |
---|---|
Provider Name | Luther J Willmore |
First Address | St Louis, MO 63110 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 28/10/2020 |