Provider Demographics
NPI:1144294604
Name:JOHAR, RAVI S (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:S
Last Name:JOHAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:755 DUNN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1751
Mailing Address - Country:US
Mailing Address - Phone:314-801-5300
Mailing Address - Fax:314-801-5320
Practice Address - Street 1:755 DUNN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1751
Practice Address - Country:US
Practice Address - Phone:314-801-5300
Practice Address - Fax:314-801-5320
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO102938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00033609OtherRAILROAD MEDICARE
MOP01137606OtherRAILROAD MEDICARE
MO1144294604Medicaid
MOF53412Medicare UPIN
MOP01137606OtherRAILROAD MEDICARE