Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 9410M1973 | MI |
NPI | 1043292840 |
---|---|
Provider Name | Meredith B Stuart |
First Address | Ellisville, MO 63011-2103 |
Second Address | Ellisville, MO 63011-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U31206 | (02) | MO |