Provider Demographics
NPI:1861481152
Name:GIRA, JOSEPH PRAVOOT (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PRAVOOT
Last Name:GIRA
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 1:12990 MANCHESTER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1860
Mailing Address - Country:US
Mailing Address - Phone:314-909-0633
Mailing Address - Fax:314-909-0391
Practice Address - Street 1:12990 MANCHESTER RD STE 201
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1860
Practice Address - Country:US
Practice Address - Phone:314-909-0633
Practice Address - Fax:314-909-0391
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108456207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO121629OtherBCBS
MO204686703Medicaid
MO406080OtherHEALTHLINK
MO1861481152Medicaid
MO406080OtherHEALTHLINK
MO1861481152Medicaid
MO145450004Medicare PIN
001013442Medicare ID - Type Unspecified