Healthcare Provider Details

I. General information

NPI: 1588983209
Provider Name (Legal Business Name): PEDRO J. RIOS MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1081
US

IV. Provider business mailing address

660 S. EUCLID AVE CB 8054 DEPT OF ANESTHESIOLOGY
ST. LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax:
Mailing address:
  • Phone: 800-986-2199
  • Fax: 314-362-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2018008657
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036156279
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: