Provider Demographics
NPI:1215202510
Name:GRASSINO, JOSEPH JASON (MMS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JASON
Last Name:GRASSINO
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Gender:M
Credentials:MMS, PA-C
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Mailing Address - Street 1:1001 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7254
Mailing Address - Country:US
Mailing Address - Phone:314-966-8887
Mailing Address - Fax:314-966-3869
Practice Address - Street 1:1001 S KIRKWOOD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7254
Practice Address - Country:US
Practice Address - Phone:314-966-8887
Practice Address - Fax:314-966-3869
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
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Provider Licenses
StateLicense IDTaxonomies
MO2012008459363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical