Provider Demographics
NPI:1649351966
Name:STEIN, PAUL M (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-872-8470
Mailing Address - Fax:314-872-8472
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-872-8470
Practice Address - Fax:314-872-8472
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO33452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202641627Medicaid
MO33452OtherMEDICAL LICENSE
MO1682OtherBNDD
MOAS4735520OtherDEA
MO202641627Medicaid
MO33452OtherMEDICAL LICENSE