Doctor Name: | MR. RAJENDRA GAVINI |
NPI Number: | 1053501973 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | R6940 |
Business Practice Address: | 12101 Woodcrest Executive Dr Suite 210 Saint Louis, MO - 631415047 |
Business Phone Number: | 3143170600 |
Business Fax Number: | 3143170606 |
Mailing Address: | 12101 Woodcrest Executive Dr, Suite 210 SAINT LOUIS |
State: | MO |
Postal Code: | 631415047 |
Phone Number: | 3143170600 |
Fax Number: | 3143170606 |
NPI Enumeration Date: | 07/26/2007 |
NPI Last Update Date: | 04/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | R6940 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |