Provider Demographics
NPI:1609928845
Name:VERNA, JOHN (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VERNA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2328
Mailing Address - Country:US
Mailing Address - Phone:314-996-3520
Mailing Address - Fax:314-996-3525
Practice Address - Street 1:3009 N BALLAS RD STE 359C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2324
Practice Address - Country:US
Practice Address - Phone:314-996-3520
Practice Address - Fax:314-996-3525
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO085.001682363A00000X
MI5601010695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085001682OtherIL STATE LICENSE NUMBER