Healthcare Provider Details

I. General information

NPI: 1891840237
Provider Name (Legal Business Name): HASHIM SYED RAZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 100B
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

3009 N BALLAS RD STE 100B
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-1111
  • Fax: 314-432-3629
Mailing address:
  • Phone: 314-432-1111
  • Fax: 314-432-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number101414
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number101414
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number101414
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: