Healthcare Provider Details

I. General information

NPI: 1699770297
Provider Name (Legal Business Name): CATHLEEN FARIS-GUYOL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHLEEN FARIS

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD STE 220
SAINT LOUIS MO
63124-2056
US

IV. Provider business mailing address

PO BOX 957294
SAINT LOUIS MO
63195-7294
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-3336
  • Fax: 314-644-5606
Mailing address:
  • Phone: 314-644-3336
  • Fax: 314-644-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR3D19
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: