Provider Information for 1982445227
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PAUL DOHEARTY
Sex: Male
NPI: 1982445227
Last Updated: 2024-06-18
Certification Date: 2024-06-18
Certification Date: 2024-06-18
Details
Name | Value | ||||||||||||
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NPI | 1982445227 | ||||||||||||
Enumeration Date | 2024-06-03 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 22 FOREST GLEN DR BELLEVILLE, IL 62223-1800 United States Phone: 314-399-1910 | Fax: | ||||||||||||
Primary Practice Address | 11102 LINDBERGH BUSINESS CT SAINT LOUIS, MO 63123-7810 United States Phone: 314-399-1910 | Fax: | ||||||||||||
Secondary Practice Address(es) | 3309 S KINGSHIGHWAY BLVD 22 FOREST GLEN DR | ||||||||||||
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