Provider Demographics
NPI:1538519616
Name:ZHAO, FANG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:FANG
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ROSEANNE
Other - Middle Name:
Other - Last Name:ZHAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CAMPUS BOX 8121
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:CAMPUS BOX 8121
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine