MEDICARE: PAUL EDWARD PANCOAST ME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35048028	OH

General Provider Information

NPI Number	:	1699190157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL EDWARD PANCOAST ME

Provider Business Mailing Address
First Line	:	4401 S VINEYARD WAY
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-9505
Country	:	US
Telephone Number	:	214-799-6073
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 S VINEYARD WAY
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-9505
Country	:	US
Telephone Number	:	214-799-6073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/20/2014

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Directions to “ PAUL EDWARD PANCOAST ME” Practice Location

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