Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 2006002912 | MO |
NPI | 1265546923 |
---|---|
Provider Name | Patricia Sue Inman |
First Address | Chesterfield, MO 63017-4834 |
Second Address | Chesterfield, MO 63017-4834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 16/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200826907 | (05) | MO |