Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 2011002817 | MO |
NPI | 1063616506 |
---|---|
Provider Name | Natalya Rukhman |
First Address | Saint Louis, MO 63141-8232 |
Second Address | Saint Louis, MO 63141-8232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2011002817 | MO LICENSE (01) | MO |