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General NPI Number Information
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NPI Number | 1366697906
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Entity Type | Individual
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Provider Name | SHIRLEY MAE CATOIRE VISSER DPM
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Gender | Female
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 11709 OLD BALLAS RD SUITE 201
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City | CREVE COEUR
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-432-1903
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Fax | 314-432-5015
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Provider Business Mailing Address
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Address Line | 11709 OLD BALLAS RD SUITE 201
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City | CREVE COEUR
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-432-1903
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Fax | 314-432-5015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07001117AMEMBER
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07001117A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2012026027
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License Number State | MO
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