Individual
MARK DOUGLAS RAVENSCRAFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1753 STIFEL LANE DR, TOWN AND COUNTRY, MO 63017-8048
(314) 439-5113
Mailing address
1753 STIFEL LANE DR, TOWN AND COUNTRY, MO 63017-8048
(314) 439-5113
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R4F85
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110198407
RAILROAD MEDICARE
MO
05
—
202897500
—
MO
Enumeration date
09/21/2006
Last updated
10/01/2023
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