Healthcare Provider Details

I. General information

NPI: 1649768995
Provider Name (Legal Business Name): PAUL THOMAS MROTEK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DEPT
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 60352 DEPT OF ANESTHESIOLOGY
ST. LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 800-862-9980
  • Fax: 314-362-1185
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61599890
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2018013136
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: