Healthcare Provider Details

I. General information

NPI: 1245283548
Provider Name (Legal Business Name): JOHN HENRY PELOZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/10/2025
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N. OUTER 40 RD SUITE 310
CHESTERFIELD MO
63017-5058
US

IV. Provider business mailing address

14825 N. OUTER 40 RD SUITE 310
CHESTERFIELD MO
63017-5058
US

V. Phone/Fax

Practice location:
  • Phone: 314-530-6350
  • Fax: 636-812-6240
Mailing address:
  • Phone: 314-530-6350
  • Fax: 636-812-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG7094
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2022016370
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: