Healthcare Provider Details

I. General information

NPI: 1295727493
Provider Name (Legal Business Name): JUAN DANIEL CUEVAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 DE PAUL LN STE 201
BRIDGETON MO
63044-3546
US

IV. Provider business mailing address

10004 KENNERLY RD STE 137A
SAINT LOUIS MO
63128-2140
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-3312
  • Fax: 314-291-4641
Mailing address:
  • Phone: 314-842-7301
  • Fax: 314-842-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number103666
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: