Individual
PAUL J DIESFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12349 DE PAUL DR STE 100, BRIDGETON, MO 63044-2512
(314) 291-3399
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
119779
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970013400
RAILROAD MEDICARE
MO
Enumeration date
05/15/2006
Last updated
10/21/2020
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