1699834739 NPI number — DR. STEPHANIE DIANE BAUERLE D.O.

Table of content: DR. STEPHANIE DIANE BAUERLE D.O. (NPI 1699834739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699834739 NPI number — DR. STEPHANIE DIANE BAUERLE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUERLE
Provider First Name:
STEPHANIE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANIELEY
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699834739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 BUCKHURST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63021-8346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-527-9141
Provider Business Mailing Address Fax Number:
636-527-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 OLD US HIGHWAY 50 E
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63084-3397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-583-8555
Provider Business Practice Location Address Fax Number:
636-583-8559
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2006015211 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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