Provider Demographics
NPI:1083866388
Name:PAIS, FATIMA JUDITH (PA-C)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:JUDITH
Last Name:PAIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 CLOVERDALE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3431
Mailing Address - Country:US
Mailing Address - Phone:716-560-4670
Mailing Address - Fax:
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:SUITE 450
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-331-5761
Practice Address - Fax:573-331-5762
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008030950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant