Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2013017451 | MO |
Y | 207N00000X | Dermatologist | ME139288 | FL |
N | 207ND0900X | Dermatopathologist | 2013017451 | MO |
NPI | 1427213651 |
---|---|
Provider Name | Patricia Ann Missall |
First Address | Saint Louis, MO 63128-2786 |
Second Address | Saint Louis, MO 63141-8657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 01/08/2019 |