Individual
AUSTIN SOUTHMAYD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C MLS
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6000
Mailing address
130 PRAIRIE MEADOW CT, SAINT PETERS, MO 63304-7713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2022043266
MO
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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