Individual
JASON RABENOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 N NEW BALLAS RD STE 175, SAINT LOUIS, MO 63141-6884
(314) 786-2663
(314) 279-1037
Mailing address
PO BOX 31218, SAINT LOUIS, MO 63131-0218
(314) 786-2663
(314) 279-1037
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2009010059
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417122847
—
MO
Enumeration date
04/27/2008
Last updated
07/21/2022
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