Healthcare Provider Details

I. General information

NPI: 1285683888
Provider Name (Legal Business Name): OSLER JAY JUSTO GUZON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/13/2025
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 MID AMERICA PLZ DIV IM CARDIOLOGY, STE 2300
SAINT LOUIS MO
63129-0002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1291
  • Fax: 314-362-4278
Mailing address:
  • Phone: 314-362-1291
  • Fax: 314-362-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005013486
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2005013486
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: