Organization · Type 2 NPI

Southside Medical Group PC

Specialist · St. Louis, MO

NPI number 1912101486 Active

Practice location

9700 Mackenzie Rd Ste 105
St. Louis, MO 63123-5423

Call (314) 638-9100 Map

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XR77046 (MO)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1912101486

Southside Medical Group PC's National Provider Identifier is 1912101486, issued on Jun 11, 2007. The primary taxonomy on file is Specialist (174400000X), and the practice location is in St. Louis, MO. The record was last updated on Aug 28, 2009.