MEDICARE: DR. JODIE RAI 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
1	174400000X	Specialist	101761	MO
2	207V00000X	Obstetrics & Gynecology Physician	101761	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111599	OTHER	MO	BLUE CROSS BLUE SHIELD
2	177835	OTHER	MO	HEALTHLINK
3	516V38088	OTHER	MO	GROUP HEALTH PLAN
4	0701032	OTHER	MO	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1952393191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODIE RAI M.D.

Provider Business Mailing Address
First Line	:	3009 N BALLAS RD
Second Line	:	SUITE 352-C
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2322
Country	:	US
Telephone Number	:	314-996-4010
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 N BALLAS RD
Second Line	:	SUITE 352-C
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2322
Country	:	US
Telephone Number	:	314-395-8192
Fax Number	:	314-395-8196

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/17/2021

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Directions to “ DR. JODIE RAI M.D.” Practice Location

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