Provider Demographics
NPI:1952396863
Name:ORUWARI, PATRICK A (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:ORUWARI
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 1:200 HEALTH WAY DR
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1434
Mailing Address - Country:US
Mailing Address - Phone:573-438-1899
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH WAY DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1434
Practice Address - Country:US
Practice Address - Phone:573-438-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15147207R00000X
IL036-107861207P00000X
MO0151472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
196690OtherBLUE CROSS BLUE SHIELD
MO205807233Medicaid
P00211249OtherRAILROAD MEDICARE
MO915334541Medicare ID - Type Unspecified
MO205807233Medicaid
ORP00717201Medicare PIN
P00211249OtherRAILROAD MEDICARE