Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | R8F57 | MO |
NPI | 1245287051 |
---|---|
Provider Name | Susan S Berdy |
First Address | Saint Louis, MO 63141-6831 |
Second Address | Saint Louis, MO 63141-6831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 11/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E55266 | (02) | MO |