Healthcare Provider Details

I. General information

NPI: 1366438053
Provider Name (Legal Business Name): PAUL S MONROE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 706
RICHMOND VA
23226-1926
US

IV. Provider business mailing address

2369 STAPLES MILL RD SUITE 200
RICHMOND VA
23230-2918
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-8206
  • Fax: 804-285-0162
Mailing address:
  • Phone: 804-285-4465
  • Fax: 804-285-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101031995
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: