Healthcare Provider Details

I. General information

NPI: 1013908623
Provider Name (Legal Business Name): PATRICIA J AMATO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 WATSON RD
SAINT LOUIS MO
63126-1827
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-5437
  • Fax: 314-965-5439
Mailing address:
  • Phone: 314-965-5437
  • Fax: 314-965-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR6E65
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: