Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2000165889 | MO |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 2000165889 | MO |
NPI | 1134224934 |
---|---|
Provider Name | Robert W Brooker |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 15/01/2021 |