Individual
SUSAN IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1035 BELLEVUE AVE, SUITE 400, SAINT LOUIS, MO 63117-1854
(314) 925-4700
Mailing address
10777 SUNSET OFFICE DR, SUITE 310, SAINT LOUIS, MO 63127-1019
(314) 822-5900
(314) 822-5919
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
103237
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203832704
—
MO
Enumeration date
07/08/2006
Last updated
05/23/2012
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