Provider Demographics
NPI:1295756906
Name:PURI, RAMAN (MD)
Entity type:Individual
Prefix:MR
First Name:RAMAN
Middle Name:
Last Name:PURI
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 1:2475 BROADWAY BLUFFS DRIVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8128
Mailing Address - Country:US
Mailing Address - Phone:573-874-3235
Mailing Address - Fax:573-817-5917
Practice Address - Street 1:2475 BROADWAY BLUFFS DRIVE
Practice Address - Street 2:STE. 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8128
Practice Address - Country:US
Practice Address - Phone:573-874-3235
Practice Address - Fax:573-817-5917
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000171135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205204506Medicaid
H26370Medicare UPIN
001013601Medicare ID - Type Unspecified