Provider Demographics
NPI:1699708016
Name:DARA, BHAJANLAL S (MD)
Entity type:Individual
Prefix:DR
First Name:BHAJANLAL
Middle Name:S
Last Name:DARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1234 LAY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1872
Mailing Address - Country:US
Mailing Address - Phone:314-869-0370
Mailing Address - Fax:314-869-5098
Practice Address - Street 1:777 S NEW BALLAS RD STE 328W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8748
Practice Address - Country:US
Practice Address - Phone:314-869-0370
Practice Address - Fax:314-869-5098
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105728207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506118603Medicaid
MO207695529Medicaid
MO507043701Medicaid