Individual
LAWRENCE BAUDENDISTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 1ST CAPITOL DR, SAINT CHARLES, MO 63301-2844
(314) 989-3000
Mailing address
13523 BARRETT PARKWAY DR, SUITE 210, BALLWIN, MO 63021-3802
(314) 775-2816
(314) 775-2821
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R8D57
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050091961
RR MEDICARE
MO
05
—
201993110
—
MO
Enumeration date
11/22/2005
Last updated
04/29/2008
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