=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225009384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAFAT NASHED ORTHOPEDICS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2006
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2865 NETHERTON DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-4674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-355-6070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1209
-----------------------------------------------------
City | MARYLAND HEIGHTS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63043-0209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-989-0300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAFAT NASHED
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 314-355-6070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 104163
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------