Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016005901 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 2016018290 | MO |
NPI | 1023469277 |
---|---|
Provider Name | Robert Kevin Schergen JR. |
First Address | Saint Louis, MO 63195-2512 |
Second Address | Centralia, IL 62801-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 21/10/2020 |