Individual
DR. SAMUEL REYNALDO CORTEZ GRANADOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CHILDRENS PL, DIV PED ENDOCRINOLOGY AND DIABETES, SAINT LOUIS, MO 63110-1002
(314) 454-6051
(314) 454-6225
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 454-6051
(314) 454-6225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2020019635
MO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
2020019635
MO
208000000X
Pediatrics Physician
2020019635
MO
2080P0205X
Pediatric Endocrinology Physician
Primary
2020019635
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200048695
—
MO
Enumeration date
03/20/2017
Last updated
04/17/2025
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