Provider Demographics
NPI:1871594564
Name:PAMAONG, ARTURO J (MD)
Entity type:Individual
Prefix:
First Name:ARTURO
Middle Name:J
Last Name:PAMAONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 SAINT CHARLES ROCK RD
Mailing Address - Street 2:BACK PAIN INSTITUTE OF ST. LOUIS LLC
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2623
Mailing Address - Country:US
Mailing Address - Phone:314-770-0900
Mailing Address - Fax:314-739-8569
Practice Address - Street 1:11903 SAINT CHARLES ROCK RD
Practice Address - Street 2:BACK PAIN INSTITUTE OF ST. LOUIS LLC
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2623
Practice Address - Country:US
Practice Address - Phone:314-770-0900
Practice Address - Fax:314-770-1623
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8102163WP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0000XNursing Service ProvidersRegistered NursePain Management
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L03474Medicare UPIN
A09774Medicare ID - Type Unspecified