Provider Demographics
NPI:1386653731
Name:CATANZARO, PAUL S (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:CATANZARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10007 KENNERLY RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2179
Mailing Address - Country:US
Mailing Address - Phone:314-481-5000
Mailing Address - Fax:314-736-4469
Practice Address - Street 1:10007 KENNERLY RD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2179
Practice Address - Country:US
Practice Address - Phone:314-481-5000
Practice Address - Fax:314-736-4469
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1386653731Medicaid
MOP01320019OtherRAILROAD MEDICARE
MOP01320019OtherRAILROAD MEDICARE