Provider Demographics
NPI:1518401298
Name:SMITH, AIGNER
Entity Type:Individual
Prefix:MS
First Name:AIGNER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N WARSON RD
Mailing Address - Street 2:241
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1111
Mailing Address - Country:US
Mailing Address - Phone:314-922-9841
Mailing Address - Fax:314-736-1787
Practice Address - Street 1:1515 N WARSON RD
Practice Address - Street 2:241
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1111
Practice Address - Country:US
Practice Address - Phone:314-922-9841
Practice Address - Fax:314-736-1787
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization