Provider Demographics
NPI:1285727461
Name:RAZA, SAADIA TAUFIQ (MD)
Entity type:Individual
Prefix:DR
First Name:SAADIA
Middle Name:TAUFIQ
Last Name:RAZA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6704 KEATON CORP PKWY
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8680
Mailing Address - Country:US
Mailing Address - Phone:636-300-9596
Mailing Address - Fax:636-300-9598
Practice Address - Street 1:6704 KEATON CORP PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8680
Practice Address - Country:US
Practice Address - Phone:636-300-9596
Practice Address - Fax:636-300-9598
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003010750207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209080506Medicaid
935790183Medicare PIN