Basic Information
| Provider Information | |||||||||
| NPI: | 1649351966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N NEW BALLAS RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148728470 | ||||||||
| FaxNumber: | 3148728472 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N NEW BALLAS RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148728470 | ||||||||
| FaxNumber: | 3148728472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 33452 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 202641627 | 05 | MO | MEDICAID | 33452 | 01 | MO | MEDICAL LICENSE | OTHER | 1682 | 01 | MO | BNDD | OTHER | AS4735520 | 01 | MO | DEA | OTHER |