Individual
DR. DIANNE S ELFENBEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1465 S GRAND BLVD, DIVISION OF ADOLESCENT MEDICINE, SAINT LOUIS, MO 63104-1003
(314) 268-6406
(314) 268-2712
Mailing address
1465 S GRAND BLVD, DIVISION OF ADOLESCENT MEDICINE, SAINT LOUIS, MO 63104-1003
(314) 268-6406
(314) 268-2712
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2009036450
MO
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
2009036450
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3206866
—
MO
Enumeration date
10/27/2005
Last updated
06/17/2013
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