MEDICARE: DR. PAUL LOUIS MEDLER M.D.

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	207N00000X	Dermatology Physician	R4992	MO

General Provider Information

NPI Number	:	1861508228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL LOUIS MEDLER M.D.

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	SUITE 6015
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-567-1291
Fax Number	:	631-567-1227

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	SUITE 6015
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-567-1291
Fax Number	:	631-567-1227

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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