Individual
STEPHANIE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1585 WOODLAKE DR, SUITE 201, CHESTERFIELD, MO 63017-5740
(314) 878-2788
(314) 878-8988
Mailing address
6624 WATERMAN AVE, SAINT LOUIS, MO 63130-4659
(314) 863-3532
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
2005005835
MO
Other
Enumeration date
10/23/2006
Last updated
06/03/2011
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