Healthcare Provider Details

I. General information

NPI: 1467559658
Provider Name (Legal Business Name): VICTOR M PACE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 AUBERT AVE
SAINT LOUIS MO
63113-1918
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 314-449-9726
  • Fax: 314-449-9641
Mailing address:
  • Phone: 417-269-2240
  • Fax: 417-269-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number044301
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number118290
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: