Provider Demographics
NPI:1528106739
Name:ROUBEY, RAAD R (MD)
Entity type:Individual
Prefix:MR
First Name:RAAD
Middle Name:R
Last Name:ROUBEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12255 DE PAUL DR STE 600
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2515
Practice Address - Country:US
Practice Address - Phone:314-209-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108153208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0403350OtherUNITED HEALTH CARE
MO101187OtherGROUP HEALTH PLAN
MO122719OtherBLUE CROSS BLUE SHIELD
MO5274793OtherAETNA
MO109111OtherGHP/PARTNERS
MO204012918Medicaid
MO413539OtherHEALTHLINK
MO152508OtherANTHEM BLUE CROSS BLUE SH
MO413539OtherHEALTHLINK
MOG93064Medicare UPIN
MO204012918Medicaid