Healthcare Provider Details

I. General information

NPI: 1558562355
Provider Name (Legal Business Name): PERICLES XYNOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE STE 400
SAINT LOUIS MO
63117-1858
US

IV. Provider business mailing address

6420 CLAYTON RD SUITE 290
SAINT LOUIS MO
63117-1811
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-7455
  • Fax: 314-977-7477
Mailing address:
  • Phone: 314-781-8605
  • Fax: 314-646-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2005020354
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: