Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 2014024991 | MO |
N | 207QS0010X | Family Doctor - Sports Medicine | DO1771 | NV |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS16317 | FL |
NPI | 1295968311 |
---|---|
Provider Name | Dr. Adam P Pasternak |
First Address | Saint Louis, MO 63127-1646 |
Second Address | Chesterfield, MO 63005-1266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 22/12/2021 |