Organization · NPI-2

Affton Medical Clinic

Pediatrics, Adolescent Medicine · Saint Louis, MO

NPI number1114048154
StatusActive
Last updated in NPPESJun 16, 2008

Details

NPI
1114048154
Entity type
Organization (NPI-2)
Legal business name
Affton Medical Clinic
Organization subpart
No
Enumeration date
Apr 3, 2007
Last updated
Jun 16, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2080A0000X Pediatrics, Adolescent MedicineR5P40MOYes

Practice location

59 Grasso Plz
Saint Louis, MO 63123-3107

Phone 314-638-9309 · Fax 314-638-9333

Mailing address

59 Grasso Plz
Saint Louis, MO 63123-3107

Phone 314-638-9309 · Fax 314-638-9333

Authorized official

Rubilinda Gimena Casino
Medical Director
3146389309

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