Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R7D23 | MO |
NPI | 1013919844 |
---|---|
Provider Name | Ms. Guadalupe Sanchez |
First Address | St Peters, MO 63376-1622 |
Second Address | St Peters, MO 63376-1622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 20/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070001270 | RAILROAD MEDICARE (01) | |
180467 | HEALTHLINK (01) | |
202216016 | (05) | MO |
7588 | BLUE CROSS BLUE SHIELD (01) | |
A26232 | (02) |