Healthcare Provider Details

I. General information

NPI: 1427029362
Provider Name (Legal Business Name): RICARDO RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD SUITE 210D
SAINT LOUIS MO
63131-2330
US

IV. Provider business mailing address

PO BOX 790056
SAINT LOUIS MO
63179-0056
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-9229
  • Fax: 314-993-8398
Mailing address:
  • Phone: 314-989-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberR3J01
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: