Souvannarath, Daniel Zackary

Souvannarath, Daniel Zackary is an individual health care provider with primary practice located at 12266 De Paul Dr Ste 310 , Bridgeton MO 63044-2562. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Souvannarath, Daniel Zackary can be contacted via phone (314) 209-5171.

Contact Information

Primary practice address
12266 De Paul Dr Ste 310 Bridgeton MO 63044-2562
Phone: (314) 209-5171
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2021010216 Missouri

Profile Details

NPI number 1174144828
LBN Legal business name Souvannarath, Daniel Zackary
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2020
Last updated Sep 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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