Organization
ROUBA GHOUSSOUB MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROUBA GHOUSSOUB M.D. (OWNER)
(636) 931-7770
Entity
Organization
Contact information
Practice address
1400 US HIGHWAY 61, G30, FESTUS, MO 63028-4100
(636) 931-7770
(636) 931-7671
Mailing address
PO BOX 1449, MARYLAND HEIGHTS, MO 63043-0449
(314) 432-2580
(314) 432-0223
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417349234
—
MO
Enumeration date
03/03/2015
Last updated
04/23/2015
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