Theodore G. Sample JR. M.D.

NPI 1922191584 - Pediatrics - 208000000X

NPI Details
NPI 1922191584
Gender Male
Enumeration Date 10/02/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
621 S. NEW BALLAS ROAD
SUITE 6009-B
ST. LOUIS MO, 63141, US
Phone (314) 251-6598
Fax (314) 251-7990
Business Location
621 S. NEW BALLAS ROAD
SUITE 6009-B
ST. LOUIS MO, 63141, US
Phone (314) 251-6598
Fax (314) 251-7990
Toxanomy
Taxonomy Code 208000000X
License State Missouri
License Number 112824
Remove 1922191584 NPI Number
 

According to our database, Theodore G. Sample JR. M.D. NPI is 1922191584, taxonomy code is 208000000X and license number is 112824, license state is located at Missouri. Theodore G. Sample JR. M.D. physically located at 621 S. New Ballas Road, St. Louis MO, 63141. NPI Number Theodore G. Sample JR. M.D. has the Individual type.

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1922191584 NPI number is provided on an as is basis without warranty of any kind. 1922191584 is maintained by the National Plan & Provider Enumeration System. The contents of Theodore G. Sample JR. M.D. are for informational purposes only.