Healthcare Provider Details

I. General information

NPI: 1881822617
Provider Name (Legal Business Name): RUBAB HASAN NAQVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUBAB KHALIL

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W NIFONG STE 101
COLUMBIA MO
65203-3032
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-4400
  • Fax: 573-815-6634
Mailing address:
  • Phone: 573-499-4400
  • Fax: 573-815-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number003886
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014020126
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2014020126
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: