Healthcare Provider Details

I. General information

NPI: 1730139833
Provider Name (Legal Business Name): MARIO A SALINAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 395B
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

10004 KENNERLY RD STE 395B
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-3500
  • Fax: 314-849-4422
Mailing address:
  • Phone: 314-849-3500
  • Fax: 314-849-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35863
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: