Individual
RAVI KOTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
HWY 61 SOUTH, CRYSTAL CITY, MO 63019
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 827431, PHILADELPHIA, PA 19182-7431
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2003021689
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124884
BLUE CROSS
MO
05
—
208824110
—
MO
01
—
222382593
CHAMPUS
MO
01
—
426403
HEALTHLINK
MO
01
—
947071631
MERCY HEALTH
MO
01
—
P00066451
RAILROAD MEDICARE
MO
Enumeration date
06/13/2006
Last updated
01/28/2011
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