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General NPI Number Information
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NPI Number | 1790731545
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Entity Type | Individual
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Provider Name | ANGELA M HOLBROOK M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 605 E BOONESLICK RD
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City | WARRENTON
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State | MO
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Zip | 63383-2127
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Country | US
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Telephone | 636-456-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 LACKLAND HILL PKWY ATTN: CREDENTIALING
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3572
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Country | US
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Telephone | 314-989-0300
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Fax | 314-810-1399
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 103133
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 103133
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License Number State | MO
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