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Individual

MR. ENRIQUE PASTRANA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1011 BOWLES AVE., SUITE 300, FENTON, MO 63026-2387
(636) 496-5030
(636) 496-5035
Mailing address
1011 BOWLES AVE., SUITE 300, FENTON, MO 63122-2387
(636) 496-5030
(636) 496-5035

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R1P02
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
208176503
MO
Enumeration date
08/24/2005
Last updated
06/08/2012
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