| NPI | 1508035569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI JEANE RUDDLE Administrator 314-270-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 000552) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2017-06-13 |