Healthcare Provider Details

I. General information

NPI: 1497323729
Provider Name (Legal Business Name): ALEXA CHANOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 2009B
SAINT LOUIS MO
63141-8265
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6062
  • Fax:
Mailing address:
  • Phone: 314-251-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2021021958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: