Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | MD35763 | MO |
NPI | 1568550986 |
---|---|
Provider Name | Mr. Jorge A Pineda |
First Address | Chesterfield, MO 63017-3662 |
Second Address | Chesterfield, MO 63017-3662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A-27812 | (02) | MO |