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General NPI Number Information
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NPI Number | 1962427229
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Entity Type | Individual
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Provider Name | ANJUM RAZZAQUE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2630 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-6624
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Country | US
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Telephone | 636-980-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CLAYTON TER
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2918
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Country | US
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Telephone | 314-989-0833
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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 | R7P08
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License Number State | MO
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