Healthcare Provider Details

I. General information

NPI: 1013919844
Provider Name (Legal Business Name): GUADALUPE SANCHEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date: 12/16/2014
Reactivation Date: 08/20/2015

III. Provider practice location address

70 JUNGERMANN CIR SUITE 203
ST PETERS MO
63376-1622
US

IV. Provider business mailing address

70 JUNGERMANN CIR #203, FAMILY DERMATOLOGY CENTER LC
ST PETERS MO
63376-1622
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-5197
  • Fax: 636-928-0994
Mailing address:
  • Phone: 636-447-5197
  • Fax: 636-928-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR7D23
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: