Healthcare Provider Details

I. General information

NPI: 1285727461
Provider Name (Legal Business Name): SAADIA TAUFIQ RAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 KEATON CORP PKWY
O FALLON MO
63368-8680
US

IV. Provider business mailing address

6704 KEATON CORP PKWY
O FALLON MO
63368-8680
US

V. Phone/Fax

Practice location:
  • Phone: 636-300-9596
  • Fax: 636-300-9598
Mailing address:
  • Phone: 636-300-9596
  • Fax: 636-300-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2003010750
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2003010750
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2003010750
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: