Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2011007277 | MO |
N | 207NS0135X | Procedural Dermatology | 2011007277 | MO |
NPI | 1124223011 |
---|---|
Provider Name | Ramona Behshad |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63122-3383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 22/02/2021 |