Daniel Zackary Souvannarath, - Medicare Physician Assistant in Bridgeton, MO

Daniel Zackary Souvannarath, is a medicare enrolled "Physician Assistant" in Bridgeton, Missouri. His current practice location is 12266 De Paul Dr Ste 310, Bridgeton, Missouri. You can reach out to his office (for appointments etc.) via phone at (314) 209-5171.

Daniel Zackary Souvannarath is licensed to practice in Missouri (license number 2021010216) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1174144828.

Contact Information

Daniel Zackary Souvannarath,
12266 De Paul Dr Ste 310,
Bridgeton, MO 63044-2562
(314) 209-5171
Not Available



Provider's Profile

Full NameDaniel Zackary Souvannarath
GenderMale
SpecialityPhysician Assistant
Location12266 De Paul Dr Ste 310, Bridgeton, Missouri
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1174144828
  • Provider Enumeration Date: 05/05/2020
  • Last Update Date: 09/13/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 1759787468
  • Enrollment ID: I20210903001882

Medical Identifiers

Medical identifiers for Daniel Zackary Souvannarath such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1174144828NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant (* (Not Available))Secondary
363A00000XPhysician Assistant 2021010216 (Missouri)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Daniel Zackary Souvannarath is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Daniel Zackary Souvannarath,
Po Box 955534,
Saint Louis, MO 63195-5534

Ph: () -
Daniel Zackary Souvannarath,
12266 De Paul Dr Ste 310,
Bridgeton, MO 63044-2562

Ph: (314) 209-5171

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› Verified 3 days ago


Physician Assistant Nurses in Bridgeton, MO

Mr. Blessing Kudakwashe Tupiri, PA
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 12266 De Paul Dr Ste 205, Bridgeton, MO 63044
Phone: 314-647-8269    
Ms. Jennifer Cafi, PA
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 12303 De Paul Dr, Bridgeton, MO 63044
Phone: 314-344-6000    Fax: 314-344-6840
Heather Ann Schmitz, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 12266 De Paul Dr Ste 205, Bridgeton, MO 63044
Phone: 314-218-2300    
Madelyn Tegerdine, PA
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 12266 De Paul Dr Ste 205, Bridgeton, MO 63044
Phone: 314-218-2300    
Mrs. Amber Renee Johnson, PAC MMS
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 12255 De Paul Dr, Suite 460, Bridgeton, MO 63044
Phone: 314-770-1844    Fax: 314-770-1843
Abigail Groos, PA-C
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 12303 De Paul Dr, Bridgeton, MO 63044
Phone: 314-344-6000    

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