Provider Demographics
NPI:1699815449
Name:CANIZARES, MARIA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:JEAN
Last Name:CANIZARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 MEDICAL PLZ
Mailing Address - Street 2:MOB 2, SUITE 210
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1481
Mailing Address - Country:US
Mailing Address - Phone:636-561-0026
Mailing Address - Fax:636-561-0023
Practice Address - Street 1:300 MEDICAL PLZ
Practice Address - Street 2:MOB 2, SUITE 210
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1481
Practice Address - Country:US
Practice Address - Phone:636-561-0026
Practice Address - Fax:636-561-0023
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002031471207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology