Healthcare Provider Details

I. General information

NPI: 1326334343
Provider Name (Legal Business Name): HUZAIFA QUAIZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD STE 2427
SAINT LOUIS MO
63136-6119
US

IV. Provider business mailing address

11133 DUNN RD STE 2427
SAINT LOUIS MO
63136-6163
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5643
  • Fax: 314-653-5648
Mailing address:
  • Phone: 314-653-5643
  • Fax: 314-653-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2013017454
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: