Individual
SAMER THANAVARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11125 DUNN RD, SUITE 204, SAINT LOUIS, MO 63136-6132
(314) 839-5522
(314) 839-5351
Mailing address
11125 DUNN RD, SUITE 204, SAINT LOUIS, MO 63136-6132
(314) 839-5522
(314) 839-5351
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036072313
IL
207RC0000X
Cardiovascular Disease Physician
Primary
R6765
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012939
ESSENCE
—
01
—
060067960
ILRRMCR
IL
01
—
110099256
MORRMCR
MO
01
—
119171
HLNK
—
01
—
1259965
CIGNA
—
05
—
200998417
—
MO
01
—
2333V3831
GHP/CMR
—
01
—
2500083
UHC
—
01
—
4037808
AETNA
—
01
—
431098908
TRICARE
—
01
—
43336V30946
HLTHPART
—
01
—
7268V8816
HCUSA
—
01
—
A13504
MERCY
—
Enumeration date
08/25/2005
Last updated
12/02/2021
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