MEDICARE: DR. RAJIV L YADAVA DO

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
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	R5P82	MO

General Provider Information

NPI Number	:	1629117742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJIV L YADAVA DO

Provider Business Mailing Address
First Line	:	2355 DOUGHERTY FERRY RD STE 320
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-821-7577
Fax Number	:	314-821-9199

Provider Business Practice Location Address
First Line	:	2355 DOUGHERTY FERRY RD STE 320
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-821-7577
Fax Number	:	314-821-9199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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