Individual
DR. ANDREA R SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12277 DE PAUL DR STE 305, BRIDGETON, MO 63044-2529
(314) 344-7585
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2006012211
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
2006012211
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2006012211
MISSOUIR LICENSE
MO
Enumeration date
09/21/2006
Last updated
10/26/2020
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