Organization
AFFTON MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUBILINDA GIMENA CASINO MD (MEDICAL DIRECTOR)
(314) 638-9309
Entity
Organization
Contact information
Practice address
59 GRASSO PLZ, SAINT LOUIS, MO 63123-3107
(314) 638-9309
(314) 638-9333
Mailing address
59 GRASSO PLZ, SAINT LOUIS, MO 63123-3107
(314) 638-9309
(314) 638-9333
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
R5P40
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205357908
—
MO
Enumeration date
04/03/2007
Last updated
06/16/2008
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