Provider Demographics
NPI:1902977432
Name:DRAGO, JOSEPH J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:DRAGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12255 DE PAUL DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-291-6202
Mailing Address - Fax:314-291-6208
Practice Address - Street 1:12255 DEPAUL DRIVE
Practice Address - Street 2:SUITE 800
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-291-6202
Practice Address - Fax:314-291-6208
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO000471213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO301864906Medicaid
MO0932310001Medicare NSC
MO301864906Medicaid
MO000021149Medicare PIN