Organization
BLUE BAYOU SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BRONSON (CEO)
(314) 502-1300
Entity
Organization
Contact information
Practice address
1310 PAPIN ST, SAINT LOUIS, MO 63103-3132
(314) 502-1300
Mailing address
1310 PAPIN ST, SAINT LOUIS, MO 63103-3132
(314) 502-1300
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
12345
MO
Other
Enumeration date
08/07/2012
Last updated
09/18/2012
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