Individual
TIMOTHY JAMES NIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.PED
Contact information
Practice address
4921 PARKVIEW PL, SUITE 6A, SAINT LOUIS, MO 63110-1032
(314) 747-2545
Mailing address
3651 CINNAMON TREE LN, SAINT LOUIS, MO 63129-2251
(314) 600-8237
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CPED2590
MO
Other
Enumeration date
12/16/2009
Last updated
12/16/2009
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