DR. FERNANDO RAFAEL MEDINA CARBONELL


Address: 1465 S Grand Blvd, Saint Louis, MO 63104-1003
Phone: 3142684010

DR. FERNANDO RAFAEL MEDINA CARBONELL (NPI# 1467747659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1467747659
Entity Type Individual
Full Name DR. FERNANDO RAFAEL MEDINA CARBONELL
Credential M.D.
Practice Address 1465 S Grand Blvd
Saint Louis
MO 63104-1003
Mailing Address 1465 S Grand Blvd Dept Of
Saint Louis
MO 63104-1003
Practice Telephone 3142684010
Practice Fax Number 3142682775
Mailing Telephone 3142684010
Mailing Fax Number 3142682775
Enumeration Date 2011-06-15
Last Update Date 2020-10-26
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2080P0206X Pediatrics
Specialization: Pediatric Gastroenterology
2020001532 MO Allopathic & Osteopathic Physicians
N 2080P0206X Pediatrics
Specialization: Pediatric Gastroenterology
29938 NE Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

Address Telephone Number Fax Number
111 N 84th St, Omaha, NE 681144101 4029555700
4502 Medical Dr, San Antonio, TX 782294402 2103584000
982161 Nebraska Medical Ctr, Omaha, NE 68198 4025592412

Office Location

Street Address 1465 S GRAND BLVD
City SAINT LOUIS
State MO
Zip Code 63104-1003

Providers in the same location

NPI Name Taxonomy Address Enumeration
1528676921 Gunjanpreet Kaur Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-07-21
1972128510 Millicent Rose Palacios Nurse Practitioner 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-06-09
1083241863 Nathaniel Joseph Conner Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1467089177 Stacy Kollanur Mathews Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1568099299 Susan Aye Mya Oo Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1861029514 Gregory Joseph Weissler II Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1154958874 Brendan Michael Mcenery Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1316574049 Satvika Mikkilineni Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1972130607 Katherine Letha Randolph Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
1346877081 Samuel Ryan Richey Student in an Organized Health Care Education/Training Program 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2020-03-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1407469570 Family Care Health Centers Clinic/Center 2717 Sidney Street, St. Louis, MO 63104 2020-08-28
1023638038 Laura Ann Humphrey Physician Assistant Allied Health Building 3437 Caroline Street, Room 3015, Saint Louis, MO 63104 2020-04-20
1174187264 Ahsan Ali Student in an Organized Health Care Education/Training Program 1438 South Grand Blvd, Monteleone Hall, St. Louis, MO 63104 2019-04-24
1205359916 Brenda Eve Ladin Behavior Technician 1221 Allen Market Lane Rear, St. Louis, MO 63104 2017-07-25
1841722063 Gustavo G Mendez Student in an Organized Health Care Education/Training Program 1465 South Grand Bulevard Rm 2717, Ssm Health Cardinal Glennon Children's Hospital, Saint Louis, MO 63104 2017-03-28
1053776716 Carmella Harper Respiratory Therapist, Certified 2678 Park Ave, St Louis, MO 63104 2015-12-23
1922485986 Alexander Tremont Internal Medicine 1402 S Grand Blvd Rm M260, Saint Louis, MO 63104 2015-04-29
1306233341 Healthcare R Us Home Health 2859 Sidney St, St Louis, MO 63104 2015-04-16
1396159091 Daniela Hermelin Pathology 1402 South Grane, St. Louis, MO 63104 2014-06-20
1992117881 Kelly Denise Durbin Social Worker 1920 S 7th St, Saint Louis, MO 63104 2014-05-27
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Taxonomy Information

Taxonomy Code 2080P0206X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics
Specialization Pediatric Gastroenterology

Taxonomy Definition

A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1366920118 Danielle Marie Kenner Pediatrics 615 S New Ballas Rd Ste Yg230, Saint Louis, MO 63141-8221 2018-08-03
1689986382 Rachel Kassel Pediatrics 1 Childrens Pl # 3s34, Saint Louis, MO 63110-1002 2010-07-09
1033352885 Mercy Clinic Kids Gi, LLC Pediatrics 621 S New Ballas Rd, Suite 140-a, Saint Louis, MO 63141-8232 2009-04-09
1508085382 St Louis University Pediatrics 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2007-04-24
1215954771 Ross William Shepherd Pediatrics 1 Childrens Pl, Saint Louis, MO 63110-1002 2006-07-17
1528086048 Phillip Irwin Tarr Pediatrics 1 Childrens Pl, Saint Louis, MO 63110-1002 2006-07-17

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1003383258 Jose J. Derdoy, Md, LLC Pediatrics 845 N New Ballas Ct Ste 330, Creve Coeur, MO 63141-7169 2018-10-25
1679699060 Children's Gastroenterology of St. Louis, P.C. Pediatrics 224 S Woods Mill Rd Ste 640, Chesterfield, MO 63017-3451 2007-03-21
1366550261 Jose Lorenzo Tirol Cocjin Pediatrics 2401 Gilham Rd Children's Mercy Hospitals and Clinic, Pediatric Gastroenterology, Kansas City, MO 64108 2006-08-29
1952361081 David Richard Fleisher Pediatrics University of Missouri School of Medicine, Dept of Child Health. 1 Hospital Drive, Columbia, MO 65212 2006-03-24
1235510900 Panamdeep Kaur Pediatrics 2401 Gillham Rd, Kansas City, MO 64108 2015-06-17
1194089557 Roopali Mittal Pediatrics 404 N Keene St, Columbia, MO 65201 2012-06-30
1255622452 Nadia Ibrahimi Pediatrics 2401 Gillham Rd, Kansas City, MO 64108-4619 2011-04-22
1356652606 Abhishek Watts Pediatrics 1965 S Fremont Ave, Suite 220, Springfield, MO 65804-2201 2010-07-01
1346472461 Daniel Raphael Levinson Pediatrics 1 Children's Place, St Louis, MO 63110-1002 2009-08-24
1952566994 Valentina Shakhnovich Pediatrics 2401 Gillham Rd, Kansas City, MO 64108-4619 2008-07-18
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Competitor

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City SAINT LOUIS
Zip Code 63104

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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