Provider Demographics
NPI:1487016390
Name:AVILA GUERRA, MAURICIO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:JOSE
Last Name:AVILA GUERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAURICIO
Other - Middle Name:J
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1008 S SPRING AVE RM 3100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:146-173-5463
Mailing Address - Fax:314-617-3430
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-617-3420
Practice Address - Fax:314-617-3430
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023009168207T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program