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General NPI Number Information
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NPI Number | 1760470462
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Entity Type | Individual
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Provider Name | PAUL J SHEEHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 12255 DEPAUL DRIVE SUITE 830
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-291-6556
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Fax | 314-291-0984
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Provider Business Mailing Address
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Address Line | 12255 DEPAUL DRIVE SUITE 830
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-291-6556
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Fax | 314-291-0984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | R8A26
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License Number State | MO
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