Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2010032833 | MO |
N | 111NI0900X | Internist | 2010032833 | MO |
N | 207R00000X | Internist | 47257 | MN |
N | 111NI0900X | Internist | 47257 | MN |
Y | 207RN0300X | Nephrologist | 2010032833 | MO |
N | 207RN0300X | Nephrologist | 47257 | MN |
N | 207RN0300X | Nephrologist | 51102-20 | WI |
NPI | 1013973213 |
---|---|
Provider Name | Furqan F Raja |
First Address | Saint Peters, MO 63376 |
Second Address | Saint Peters, MO 63376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 11/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000014027 | (02) | MO |