Healthcare Provider Details

I. General information

NPI: 1124482799
Provider Name (Legal Business Name): PATRICK SCHOENWALDER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BIDDLE ST
SAINT LOUIS MO
63106-3454
US

IV. Provider business mailing address

PO BOX 551
SAINT LOUIS MO
63188-0551
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-1700
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-898-1700
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2016008787
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: