Basic Information
| Provider Information | |||||||||
| NPI: | 1528198439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELLECHIA | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11155 DUNN RD STE 315E | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143557500 | ||||||||
| FaxNumber: | 3143553287 | ||||||||
| Practice Location | |||||||||
| Address1: | 11155 DUNN RD STE 315E | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143557500 | ||||||||
| FaxNumber: | 3143553287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2005035361 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.