Individual
MR. RAJENDRA GAVINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12101 WOODCREST EXECUTIVE DR, SUITE 210, SAINT LOUIS, MO 63141-5047
(314) 317-0600
(314) 317-0606
Mailing address
12101 WOODCREST EXECUTIVE DR, SUITE 210, SAINT LOUIS, MO 63141-5047
(314) 317-0600
(314) 317-0606
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
R6940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053501973
—
MO
Enumeration date
07/26/2007
Last updated
04/22/2014
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