Provider Demographics
NPI:1194219261
Name:DESSAIN, ALICIA GABRIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:GABRIELLE
Last Name:DESSAIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5641
Mailing Address - Fax:314-362-0369
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV PA ANATOMIC AND MOLECULAR PATH
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-5641
Practice Address - Fax:314-362-0369
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2023-05-25
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Provider Licenses
StateLicense IDTaxonomies
MO2021049872207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200120916Medicaid