Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2016021529 | MO |
N | 207T00000X | Neurosurgeon | 2020039509 | MO |
NPI | 1114378551 |
---|---|
Provider Name | Rupen Rajesh Desai |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 02/12/2020 |