Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0456 | MO |
NPI | 1396701108 |
---|---|
Provider Name | Mr. Chris Robert Guerrieri |
First Address | Gladstone, MO 64119-2036 |
Second Address | Gladstone, MO 64119-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 17/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T42421 | (02) | MO |