Healthcare Provider Details

I. General information

NPI: 1699270207
Provider Name (Legal Business Name): MITCHELL ROBERT PADKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD STE 200D
SAINT LOUIS MO
63131-2328
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7272
  • Fax: 314-996-6785
Mailing address:
  • Phone: 314-996-7272
  • Fax: 314-996-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2024049655
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29192
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65901
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number65901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: