Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 114741 | MO |
NPI | 1497720825 |
---|---|
Provider Name | Dr. George Arthur Paletta JR. |
First Address | Chesterfield, MO 63017-2026 |
Second Address | Chesterfield, MO 63017-2026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G20068 | (02) | MO |