Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 104036 | MO |
Y | 213ES0000X | Sports Medicine | 104036 | MO |
NPI | 1144214065 |
---|---|
Provider Name | Ravi Yadava |
First Address | Saint Louis, MO 63141-7083 |
Second Address | Saint Louis, MO 63141-7083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G48540 | (02) | MO |