Healthcare Provider Details

I. General information

NPI: 1043487796
Provider Name (Legal Business Name): GUILLERMO LINARES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GUILLERMO LINARES TAPIA MD

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

3660 VISTA AVE
SAINT LOUIS MO
63110-2540
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4800
  • Fax: 314-977-4876
Mailing address:
  • Phone: 314-977-4800
  • Fax: 314-977-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number051107
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number042.0013868
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number042.0013868
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD443607
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number2020001912
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: