Healthcare Provider Details

I. General information

NPI: 1003064635
Provider Name (Legal Business Name): HALA YAMOUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD M260
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

18 S KINGSHIGHWAY BLVD APT 8U
SAINT LOUIS MO
63108-1356
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-9853
  • Fax:
Mailing address:
  • Phone: 314-605-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2008015354
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: