Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2009023923 | MO |
Y | 208600000X | Surgeon | 2009023923 | MO |
N | 2086S0102X | Surgical Critical Care | 2009023923 | MO |
NPI | 1104023886 |
---|---|
Provider Name | Mrs. Alison Jane Gildehaus |
First Address | Saint Louis, MO 63141-8261 |
Second Address | Saint Louis, MO 63141-8261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 23/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104023886 | (05) | MO |
2009023923 | LICENSE (01) | MO |
803537998 | BNDD (01) | MO |
FW1350379 | DEA (01) | MO |