Provider Demographics
NPI:1538485842
Name:SOETAERT, JOSEPH ANDREW (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:SOETAERT
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-273-3376
Mailing Address - Fax:888-665-8309
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-273-3376
Practice Address - Fax:888-665-8309
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010006472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220029608Medicaid