Individual
THOMAS J. STAUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1906 POWDERHORN PASS CT, WILDWOOD, MO 63011-1717
(636) 458-4188
Mailing address
1906 POWDERHORN PASS CT, WILDWOOD, MO 63011-1717
(636) 458-4188
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
105229
MO
207P00000X
Emergency Medicine Physician
105229
MO
207R00000X
Internal Medicine Physician
105229
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679568570
—
MO
05
—
208237339
—
MO
01
—
383495136
BLUE CROSS BLUE SHIELD
MO
Enumeration date
09/16/2005
Last updated
11/23/2009
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