Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2010019834 | MO |
NPI | 1316258106 |
---|---|
Provider Name | Olivier Deigni |
First Address | Saint Louis, MO 63110-1348 |
Second Address | Saint Louis, MO 63104-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 25/06/2010 |