Individual
DR. AVIVA H RASKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8420 DELMAR BLVD, 505, SAINT LOUIS, MO 63124-2170
(314) 749-6621
(314) 569-3162
Mailing address
PO BOX 957723, SAINT LOUIS, MO 63195-7723
(314) 432-2580
(314) 569-3162
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2002011264
MO
2084P0800X
Psychiatry Physician
Primary
2002011264
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201422
BLUECHOICE
MO
01
—
201766046
TAX ID#
MO
01
—
201911
BCBS
MO
05
—
207205501
—
MO
01
—
266892
GHP/CMR
MO
01
—
731022
HEALTHLINK
MO
01
—
P00278493
INDIVIDUAL PROV#
MO
Enumeration date
06/17/2006
Last updated
02/03/2014
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