Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 108419 | MO |
N | 207RG0300X | Geriatric Medicine | 108419 | MO |
NPI | 1053322685 |
---|---|
Provider Name | Syed H Tariq |
First Address | St Louis, MO 63110 |
Second Address | St Louis, MO 63110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 24/11/2020 |