Provider Demographics
NPI:1619533890
Name:RAUF, ABDUL (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:
Last Name:RAUF
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 1:6420 CLAYTON ROAD. SSM HEALTH ST. MARY'S HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-768-8778
Mailing Address - Fax:314-768-7101
Practice Address - Street 1:6420 CLAYTON ROAD. SSM HEALTH ST. MARY'S HOSPITAL
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-768-8778
Practice Address - Fax:314-768-7101
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-12-15
Deactivation Date:2019-12-23
Deactivation Code:
Reactivation Date:2020-01-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2022011924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program