Organization
SPECIALTY & PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAYYER IBRAHIM (ADMINISTRATOR)
(314) 432-5144
Entity
Organization
Contact information
Practice address
3009 N BALLAS RD, SUITE 229A, SAINT LOUIS, MO 63131-2322
(314) 432-5144
(314) 432-2400
Mailing address
3009 N BALLAS RD, SUITE 229A, SAINT LOUIS, MO 63131-2322
(314) 432-5144
(314) 432-2400
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
109425
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208721902
—
MO
05
—
361744184
—
IL
Enumeration date
02/28/2007
Last updated
03/17/2009
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