Individual
MICHAEL G DE LA PAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10296 BIG BEND RD, SUITE 205, SAINT LOUIS, MO 63122
(314) 315-9911
(314) 872-8069
Mailing address
215 DUNN RD, FLORISSANT, MO 63031-7928
(314) 315-9913
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
20050250831
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00250022
PALMETTO RR MEDICARE
MO
Enumeration date
06/22/2006
Last updated
08/23/2018
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