Healthcare Provider Details

I. General information

NPI: 1245259498
Provider Name (Legal Business Name): PROCESO T ARENOS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD SUITE 129A
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

3009 N BALLAS RD SUITE 129A
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-5377
  • Fax: 314-567-5376
Mailing address:
  • Phone: 314-567-5377
  • Fax: 314-567-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34824
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34824
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: