Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2018020014 | MO |
Y | 111NI0900X | Internist | 2018020014 | MO |
NPI | 1003300096 |
---|---|
Provider Name | Nathan Farkas |
First Address | St. Louis, MO 63110 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 21/06/2018 |