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Individual

DR. PASCAL E. GAUDREAULT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1390 US HIGHWAY 61 STE N1500, FESTUS, MO 63028
(636) 933-9300
(636) 933-9114
Mailing address
1390 US HIGHWAY 61 STE N1500, FESTUS, MO 63028-4137
(636) 933-9300
(636) 933-9114

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
K9279
TX
207Q00000X
Family Medicine Physician
Primary
2018021841
MO
207Q00000X
Family Medicine Physician
K9279
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080162163
RAILROAD MEDICARE
05
129533904
TX
Enumeration date
09/16/2005
Last updated
11/29/2018
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