Healthcare Provider Details

I. General information

NPI: 1427035955
Provider Name (Legal Business Name): GURPREET S. PADDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 WOODSON RD. SUITE 100
ST.LOUIS MO
63134
US

IV. Provider business mailing address

4477 WOODSON RD. SUITE 100
ST.LOUIS MO
63134
US

V. Phone/Fax

Practice location:
  • Phone: 314-481-5000
  • Fax: 314-481-3037
Mailing address:
  • Phone: 314-481-5000
  • Fax: 314-481-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number100572
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number100572
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: