Healthcare Provider Details

I. General information

NPI: 1366064909
Provider Name (Legal Business Name): TAVIA RIOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2066
  • Fax: 314-362-2357
Mailing address:
  • Phone: 314-747-2066
  • Fax: 314-362-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2026027600
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: