Provider Demographics
NPI:1932377678
Name:SETH PASKON M.D.
Entity type:Organization
Organization Name:SETH PASKON M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PASKON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-438-4322
Mailing Address - Street 1:1 KWAN PLZ
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1435
Mailing Address - Country:US
Mailing Address - Phone:573-438-4322
Mailing Address - Fax:573-438-5363
Practice Address - Street 1:1 KWAN PLZ
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1435
Practice Address - Country:US
Practice Address - Phone:573-438-4322
Practice Address - Fax:573-438-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
MOMDR5003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO593788508Medicaid
MO263882Medicare Oscar/Certification