Individual
SYBILLE PRUSTANE GUEMGHE TALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
916 OLIVE ST, SAINT LOUIS, MO 63101-1400
(314) 436-9300
Mailing address
5422 DELMAR BLVD, SAINT LOUIS, MO 63112-3104
(313) 234-3171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2020037813
MO
207R00000X
Internal Medicine Physician
Primary
2020037813
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020037813
ASSISTANT PHYSICIAN LICENSE NUMBER
MO
Enumeration date
11/17/2020
Last updated
11/17/2020
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