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General NPI Number Information
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NPI Number | 1497774673
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Entity Type | Organization
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Legal Business Name | WEST FLORISSANT INTERNISTS, INC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 3165 MCKELVEY RD STE 100
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-739-1333
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Fax | 314-739-1350
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Provider Business Mailing Address
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Address Line | 3165 MCKELVEY RD STE 100
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City | BRIDGETON
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State | MO
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Zip | 63044-2550
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Country | US
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Telephone | 314-739-1333
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Fax | 147-391-3503
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Authorized Official
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Title or Position | OWNER
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Name | NAVEED RAZZAQUE
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Credential | M.D.
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Telephone | 314-837-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | RIE67
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License Number State | MO
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