Individual
DR. MICHAEL SCOTT BOEDEFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 BOWLES AVE STE 202, FENTON, MO 63026-2308
(636) 386-7222
(636) 386-7810
Mailing address
4800 MEXICO RD STE 101, SAINT PETERS, MO 63376-1666
(636) 442-5035
(636) 442-5036
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2004009978
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2004009978
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207320102
—
MO
Enumeration date
01/12/2006
Last updated
10/20/2020
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