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NPI Code Detail

MEDICARE: SAMUEL JOSEPH PA-C

MEDICARE: SAMUEL JOSEPH PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1999134859MO

General Provider Information

NPI Number : 1730111337
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL JOSEPH PA-C
Provider Business Mailing Address
First Line : 5701 DELMAR BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63112-2617
Country : US
Telephone Number : 314-367-7848
Fax Number : 314-367-2985
Provider Business Practice Location Address
First Line : 5701 DELMAR BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63112-2617
Country : US
Telephone Number : 314-367-7848
Fax Number : 314-367-2985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 03/09/2011

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Directions to “ SAMUEL JOSEPH PA-C” Practice Location

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