Provider Demographics
NPI:1831469188
Name:GORENC, PATRICIA R (PA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:GORENC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:314-286-2900
Mailing Address - Fax:314-286-2990
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DEPT ORTHOPAEDIC SURG, STE 1500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-286-2900
Practice Address - Fax:314-286-2990
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029532363AS0400X, 363AM0700X
MO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220046098Medicaid
ILENROLLEDMedicaid