Individual
DR. DANI TAZBAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1035 BELLEVUE AVE STE 500, SAINT LOUIS, MO 63117-1843
(314) 925-4744
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036111031
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036111031
IL
207RP1001X
Pulmonary Disease Physician
036111031
IL
207RP1001X
Pulmonary Disease Physician
Primary
2014039581
MO
207RS0012X
Sleep Medicine (Internal Medicine) Physician
036111031
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111031
—
IL
01
—
207219
MEDICARE PTAN
IL
05
—
370966854011
—
IL
05
—
370966854016
—
IL
01
—
CF3444
MEDICARE RAILROAD GROUP
IL
01
—
P00421916
MEDICARE RAILROAD PIN
IL
Enumeration date
04/07/2007
Last updated
11/12/2020
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