MEDICARE: DR. NEHEMIAS ANTONIO GUEVARA RODRIGUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629649173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEHEMIAS ANTONIO GUEVARA RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	2107 S GRAND BLVD APT 801
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1641
Country	:	US
Telephone Number	:	323-618-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3655 VISTA AVE, WEST PAVILION, 3RD FL
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63110-2545
Country	:	US
Telephone Number	:	323-618-8035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	10/11/2024

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