Individual
MR. CHANDRA B. DOMMARAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 US HIGHWAY 61 STE 260, FESTUS, MO 63028-4101
(636) 933-2344
(636) 937-9031
Mailing address
1400 US HIGHWAY 61 STE 260, FESTUS, MO 63028-4101
(636) 933-2344
(636) 937-9031
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
106962
MO
207RI0200X
Infectious Disease Physician
MO106962
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205115322
—
MO
Enumeration date
07/04/2006
Last updated
04/14/2021
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