Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 2000162968 | MO |
NPI | 1003812512 |
---|---|
Provider Name | Paul S Patane |
First Address | Saint Louis, MO 63131-1721 |
Second Address | Saint Louis, MO 63131-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26615 | (02) | MO |