Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2020038003 | MO |
N | 208000000X | Pediatrician | 57271 | CT |
Y | 2080P0208X | Pediatric Infectious Diseases | 2020038003 | MO |
N | 2080P0208X | Pediatric Infectious Diseases | 57271 | CT |
NPI | 1356992630 |
---|---|
Provider Name | Wail A Hayajneh |
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 | 27/09/2019 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059508264 | DMV (01) | CT |