| NPI | 1003887175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY JOHNSON Delegated Official 314-781-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MO R4A99) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2010-01-20 |