Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2014020090 | MO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD2021-0817 | NM |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | RS2018-0404 | NM |
NPI | 1699185660 |
---|---|
Provider Name | Nicholas F. Rockefeller |
First Address | Saint Louis, MO 63117-1811 |
Second Address | Albuquerque, NM 87109-3460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 01/09/2021 |