Provider Demographics
NPI:1114131711
Name:PAJEAU, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PAJEAU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-364-9000
Mailing Address - Fax:
Practice Address - Street 1:1060 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:855-406-3324
Practice Address - Fax:573-458-8363
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097129207RH0003X
PAMD447328207RH0003X
IN01074780A207RH0003X
MO2025015742207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201270220Medicaid
IN000000914291OtherANTHEM
PA1027698370001Medicaid
IN000000914291OtherANTHEM
IN201270220Medicaid