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General NPI Number Information
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NPI Number | 1164493441
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Entity Type | Individual
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Provider Name | BARUGUR S. RAVI M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 3635 VISTA AT GRAND BLVD
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City | ST LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-577-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 HIGHLANDS PLAZA DR W APT # 111
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1303
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Country | US
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Telephone | 205-266-1321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35-08-2947-R
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | C53465
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License Number State | CA
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