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General NPI Number Information
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NPI Number | 1417349234
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Entity Type | Organization
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Legal Business Name | ROUBA GHOUSSOUB MD LLC
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 1400 US HIGHWAY 61 G30
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City | FESTUS
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State | MO
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Zip | 63028-4100
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Country | US
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Telephone | 636-931-7770
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Fax | 636-931-7671
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Provider Business Mailing Address
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Address Line | PO BOX 1449
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-0449
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Country | US
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Telephone | 314-432-2580
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Fax | 314-432-0223
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Authorized Official
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Title or Position | OWNER
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Name | ROUBA GHOUSSOUB
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Credential | M.D.
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Telephone | 636-931-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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