Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 2000153664 | MO |
NPI | 1063420818 |
---|---|
Provider Name | Margaret M Wilson |
First Address | Saint Louis, MO 63110-2515 |
Second Address | Saint Louis, MO 63110-2540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126692 | BCBS (01) | |
234125 | HARMONY (01) | |
449182 | HEALTHLINK (01) | |
4553038 | AETNA (01) | |
75334 | HEALTH ALLIANCE (01) | |
H27484 | (02) |