| Doctor Name: | DOUGLAS MAYO |
| NPI Number: | 1942674254 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2015032884 |
| Business Practice Address: | 1051 Wolfrum Rd Weldon Spring, MO - 633047625 |
| Business Phone Number: | 6363000370 |
| Business Fax Number: | |
| Mailing Address: | 50 Whitehaven Ct, SAINT CHARLES |
| State: | MO |
| Postal Code: | 633046969 |
| Phone Number: | 3146830337 |
| Fax Number: | |
| NPI Enumeration Date: | 11/24/2015 |
| NPI Last Update Date: | 11/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2015032884 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |