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NPI 1902977432

NPI 1902977432 : JOSEPH J DRAGO DPM : BRIDGETON, MO

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General NPI Number Information
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    NPI Number           |    1902977432
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    Entity Type          |    Individual 
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    Provider Name        |    JOSEPH J DRAGO DPM
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    11/13/2006
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    Last Update Date     |    11/30/2009
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Provider Practice Location Address
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    Address Line         |    12255 DEPAUL DRIVE SUITE 800
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    City                 |    BRIDGETON
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    State                |    MO
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    Zip                  |    63044-2510
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    Country              |    US
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    Telephone            |    314-291-6202
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    Fax                  |    314-291-6208
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Provider Business Mailing Address
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    Address Line         |    12255 DE PAUL DR SUITE 800
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    City                 |    BRIDGETON
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    State                |    MO
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    Zip                  |    63044-2510
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    Country              |    US
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    Telephone            |    314-291-6202
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    Fax                  |    314-291-6208
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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        |    213E00000X
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    Taxonomy Name        |    Podiatrist
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    License Number       |    000471
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    License Number State |    MO
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