Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 36741 | MO |
NPI | 1023006087 |
---|---|
Provider Name | Mark F Stroble |
First Address | Saint Louis, MO 63127-1665 |
Second Address | Saint Louis, MO 63127-1750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 23/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E60236 | (02) | MO |