Provider Demographics
NPI:1184678393
Name:PAN, MIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIN
Other - Middle Name:
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2880
Mailing Address - Country:US
Mailing Address - Phone:636-946-1152
Mailing Address - Fax:636-946-8126
Practice Address - Street 1:400 1ST CAPITOL DR
Practice Address - Street 2:SUITE 407
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2880
Practice Address - Country:US
Practice Address - Phone:636-946-1152
Practice Address - Fax:636-946-8126
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030236002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology