Provider Demographics
NPI:1699770297
Name:FARIS-GUYOL, CATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:FARIS-GUYOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:
Other - Last Name:FARIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 957294
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-7294
Mailing Address - Country:US
Mailing Address - Phone:314-644-3336
Mailing Address - Fax:314-644-5606
Practice Address - Street 1:8888 LADUE RD
Practice Address - Street 2:STE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2056
Practice Address - Country:US
Practice Address - Phone:314-644-3336
Practice Address - Fax:314-644-5606
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3D19207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13922Medicare UPIN
MO005013296Medicare ID - Type Unspecified