Basic Information
| Provider Information | |||||||||
| NPI: | 1952524548 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL STEIN, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 VANCE RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY PARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630881527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362255445 | ||||||||
| FaxNumber: | 6362255445 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N NEW BALLAS RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148728470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEIN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3148728470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | AS4735520 | 01 | DEA | OTHER | 1682 | 01 | MO | BNDD | OTHER | 26D1069810 | 01 | CLIA | OTHER |