Healthcare Provider Details

I. General information

NPI: 1770527954
Provider Name (Legal Business Name): STEVEN MICHAEL STRAUB PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MADISON ST CAPITAL REGION MEDICAL CENTER
JEFFERSON CITY MO
65101-5227
US

IV. Provider business mailing address

406 MIDDLETON DR
ASHLAND MO
65010-9876
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-5000
  • Fax:
Mailing address:
  • Phone: 573-356-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number85001658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: