Healthcare Provider Details

I. General information

NPI: 1932377678
Provider Name (Legal Business Name): SETH PASKON M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KWAN PLZ
POTOSI MO
63664-1435
US

IV. Provider business mailing address

1 KWAN PLZ
POTOSI MO
63664-1435
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-4322
  • Fax: 573-438-5363
Mailing address:
  • Phone: 573-438-4322
  • Fax: 573-438-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR5003
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SETH C PASKON
Title or Position: OWNER
Credential: MD
Phone: 573-438-4322