Provider Demographics
NPI:1760408603
Name:ARROYO, DENNIS (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ARROYO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12084 TANGLETREE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-477-2959
Mailing Address - Fax:
Practice Address - Street 1:24 DAVIS STREET
Practice Address - Street 2:MISSOURI ARMY NATIONAL GUARD
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125
Practice Address - Country:US
Practice Address - Phone:314-416-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107657363A00000X
IL085-000958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S37209Medicare UPIN
MO000085153Medicare PIN