Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 109839 | MO |
N | 207ND0900X | Dermatopathologist | 109839 | MO |
NPI | 1255324703 |
---|---|
Provider Name | Wayne Alan Breer |
First Address | Chesterfield, MO 63017-2167 |
Second Address | Chesterfield, MO 63017-2167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 03/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G59602 | (02) |