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NPI Code Detail

MEDICARE: DR. AMY JO RAVIN M.D.

MEDICARE: DR. AMY JO RAVIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician2000157500MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11518963859OTHERMONPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518963859
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY JO RAVIN M.D.
Provider Business Mailing Address
First Line : 6420 CLAYTON RD STE 290
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1811
Country : US
Telephone Number : 314-781-8605
Fax Number : 314-781-2840
Provider Business Practice Location Address
First Line : 1031 BELLEVUE AVE STE 400
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1858
Country : US
Telephone Number : 314-977-7455
Fax Number : 314-977-7343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 01/13/2021

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Directions to “ DR. AMY JO RAVIN M.D.” Practice Location

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