Individual
MR. ALLEN E MATHIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC,ATC,MS
Contact information
Practice address
845 N NEW BALLAS CT, STE130, CREVE COEUR, MO 63141-9510
(314) 997-1777
(314) 977-6277
Mailing address
845 N NEW BALLAS CT, STE130, CREVE COEUR, MO 63141-9510
(314) 997-1777
(314) 977-6277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102451
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102451
PA LICENSE
MO
Enumeration date
10/26/2006
Last updated
07/08/2007
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