Healthcare Provider Details

I. General information

NPI: 1467462911
Provider Name (Legal Business Name): MR. PAUL ALLEN DARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W LINCOLN ST
BELLEVILLE IL
62220-1902
US

IV. Provider business mailing address

7461 LESLIE DR
EDWARDSVILLE IL
62025-7735
US

V. Phone/Fax

Practice location:
  • Phone: 618-222-0111
  • Fax:
Mailing address:
  • Phone: 618-692-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: