Unknown Individual – Surgical Physician Assistant, NPI 1174596704
Surgical Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Dale Drive, Troy, Pike County, Alabama, 36079, United States
TROY, IL 622943614
Phone: (618) 667-0404
Fax: (314) 289-7034
Type: Mailing
John Cochran Division - VA St. Louis Health Care System, 915, North Grand Boulevard, Covenant Blu Grand Center, City of Saint Louis, Missouri, 63106, United States
SAINT LOUIS, MO 631061621
Phone: (314) 652-4100
Fax: (314) 289-7034
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62294)
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