Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | R5P82 | MO |
NPI | 1629117742 |
---|---|
Provider Name | Dr. Rajiv L Yadava |
First Address | St Louis, MO 63122-3325 |
Second Address | St Louis, MO 63122-3325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |