Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 34855 | MO |
N | 2080P0205X | Pediatric Endocrinologist | 34855 | MO |
NPI | 1164594883 |
---|---|
Provider Name | Mrs. Santosh Gupta |
First Address | Chesterfield, MO 63017 |
Second Address | Chesterfield, MO 63017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |