Provider Demographics
NPI:1255330429
Name:DATUIN, ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:DATUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 MID RIVERS MALL DR
Mailing Address - Street 2:SUITE 317
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1102
Mailing Address - Country:US
Mailing Address - Phone:636-244-4500
Mailing Address - Fax:636-244-4505
Practice Address - Street 1:6209 MID RIVERS MALL DR
Practice Address - Street 2:SUITE 317
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-1102
Practice Address - Country:US
Practice Address - Phone:636-244-4500
Practice Address - Fax:636-244-4505
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR37272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS37991Medicare UPIN