Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 0423186 | KS |
Y | 207RX0202X | Medical Oncology | R3D52 | MO |
NPI | 1073581864 |
---|---|
Provider Name | Rajagopal R Rangineni |
First Address | St Joseph, MO 64507-2559 |
Second Address | St Joseph, MO 64507-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 26/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056938 | BCBS OF KS FOR KS LOCATIO (01) | KS |
076129 | BCBS OF KS FOR MO LOCATIO (01) | KS |
100202480A | KANSAS MEDICAID (01) | KS |
10102028 | BLUE CROSS BLUE SHIELD (01) | MO |
1073581864 | (05) | MO |
C52285 | (02) | |
P00859666 | RR MEDICARE (01) | MO |