Healthcare Provider Details

I. General information

NPI: 1740244029
Provider Name (Legal Business Name): DEBORAH SUSAN DROSTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR (11F-10JB)
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

3612 HORN AVE
ALTON IL
62002-3175
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-894-5775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: