Individual
DR. VIVIAN MAI HATHUC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1402 S GRAND BLVD, SAINT LOUIS, MO 63104-1004
(314) 977-4547
(314) 977-7615
Mailing address
1402 S GRAND BLVD, SAINT LOUIS, MO 63104-1004
(314) 977-4547
(314) 977-7615
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
036151274
IL
207ZH0000X
Hematology (Pathology) Physician
2019035300
MO
207ZP0101X
Anatomic Pathology Physician
2019035300
MO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036151274
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2019035300
MO
390200000X
Student in an Organized Health Care Education/Training Program
173157
NC
Other
Enumeration date
06/27/2011
Last updated
02/05/2021
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