Individual
GREGORY SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
700 PASQUINELLI DR, WESTMONT, IL 60559-1382
(630) 990-9729
Mailing address
1836 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3572
(314) 989-0300
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041190036
IL
367500000X
Certified Registered Nurse Anesthetist
2004016345
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
911071603
—
MO
01
—
P00405166
RAILROAD MEDICARE
MO
Enumeration date
07/19/2006
Last updated
11/26/2019
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