Healthcare Provider Details

I. General information

NPI: 1700236072
Provider Name (Legal Business Name): GONZALO MATZUMURA UMEMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 04/17/2025
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7603
  • Fax: 314-747-5213
Mailing address:
  • Phone: 314-362-7603
  • Fax: 314-747-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020039264
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2020039264
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: