Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2006001586 | MO |
Y | 111NI0900X | Internist | 2006001586 | MO |
N | 207RH0000X | Hematologist | 2006001586 | MO |
NPI | 1063785343 |
---|---|
Provider Name | Robert Simon Mendelsohn |
First Address | St. Louis, MO 63114 |
Second Address | St. Louis, MO 63114-5814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2012 |
Last Update Date | 16/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2006001586 | STATE LICENSE NUMBER (01) | MO |