Healthcare Provider Details

I. General information

NPI: 1932780285
Provider Name (Legal Business Name): RAKESH DARA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 TESSON FERRY RD
SAINT LOUIS MO
63128-3814
US

IV. Provider business mailing address

1234 LAY RD
SAINT LOUIS MO
63124-1872
US

V. Phone/Fax

Practice location:
  • Phone: 314-330-3992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2026036457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: