Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1063696128 |
---|---|
Provider Name | Timothy D Vogl |
First Address | Saint Louis, MO 63110-1239 |
Second Address | Saint Louis, MO 63110-1239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 26/12/2007 |