Provider Demographics
NPI:1013919844
Name:SANCHEZ, GUADALUPE (MD)
Entity Type:Individual
Prefix:MS
First Name:GUADALUPE
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JUNGERMANN CIR
Mailing Address - Street 2:#203, FAMILY DERMATOLOGY CENTER LC
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1622
Mailing Address - Country:US
Mailing Address - Phone:636-447-5197
Mailing Address - Fax:636-928-0994
Practice Address - Street 1:70 JUNGERMANN CIR
Practice Address - Street 2:SUITE 203
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1622
Practice Address - Country:US
Practice Address - Phone:636-447-5197
Practice Address - Fax:636-928-0994
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-08-20
Deactivation Date:2014-12-16
Deactivation Code:
Reactivation Date:2015-08-20
Provider Licenses
StateLicense IDTaxonomies
MOR7D23207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070001270OtherRAILROAD MEDICARE
180467OtherHEALTHLINK
7588OtherBLUE CROSS BLUE SHIELD
MO202216016Medicaid
7588OtherBLUE CROSS BLUE SHIELD
070001270OtherRAILROAD MEDICARE