Individual
YASUO ISHIDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 PROGRESS PKWY # A, SULLIVAN, MO 63080-2359
(573) 468-6011
(573) 468-7868
Mailing address
6744 CLAYTON RD, SAINT LOUIS, MO 63117-1637
(314) 645-6100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
33207
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
33207
MO
Other
Enumeration date
12/20/2005
Last updated
08/29/2012
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