Provider Demographics
NPI:1689631194
Name:COVERT, RICHARD A (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:COVERT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE SQ
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1817
Mailing Address - Country:US
Mailing Address - Phone:314-731-9675
Mailing Address - Fax:314-731-2522
Practice Address - Street 1:1 VILLAGE SQ
Practice Address - Street 2:SUITE A
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-9675
Practice Address - Fax:314-731-2522
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-45182083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAC9485447Medicaid
ARE-16946Medicare UPIN
ARAC9485447Medicaid