Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R2E88 | MO |
Y | 2080P0202X | Pediatric Cardiologist | R2E88 | MO |
NPI | 1144326315 |
---|---|
Provider Name | Saadeh B Al-Jureidini |
First Address | St. Louis, MO 63110-2515 |
Second Address | St. Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 31/07/2015 |