Individual
DR. FREDERICK DURLIN BAUSCHARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6451 CHIPPEWA ST, STE 2, SAINT LOUIS, MO 63109-2104
(314) 832-6803
(314) 832-8072
Mailing address
6451 CHIPPEWA ST, STE 2, SAINT LOUIS, MO 63109-2104
(314) 832-6803
(314) 832-8072
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
R4202
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0300003
UNITED HEALTHCARE
MO
01
—
17657
BLUE SHIELD
MO
Enumeration date
06/24/2005
Last updated
07/08/2007
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