Provider Demographics
NPI:1215945720
Name:TESSER, PAUL MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARTIN
Last Name:TESSER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14319 WAINRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2929
Mailing Address - Country:US
Mailing Address - Phone:314-205-8286
Mailing Address - Fax:
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:STE. 700S
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-469-1122
Practice Address - Fax:314-469-6709
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO108445207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG18623Medicare UPIN
MO908984100Medicare PIN