Individual
DR. FERNANDO RAFAEL MEDINA CARBONELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-4010
(314) 268-2775
Mailing address
1465 S GRAND BLVD, DEPT OF PEDIATRICS, SAINT LOUIS, MO 63104-1003
(314) 268-4010
(314) 268-2775
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
2020001532
MO
2080P0206X
Pediatric Gastroenterology Physician
29938
NE
Other
Enumeration date
06/15/2011
Last updated
01/18/2021
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