Individual
MABLENE BUGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2620 S 13TH ST, SAINT LOUIS, MO 63118-1838
(314) 534-0043
(314) 909-0330
Mailing address
2620 S 13TH ST, SAINT LOUIS, MO 63118-1838
(314) 534-0043
(314) 909-0330
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-085587
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085587
—
IL
01
—
06032182
BLUE CROSS BLUE SHIELD
IL
05
—
1821092214
—
MO
05
—
202943346
—
MO
01
—
3932056
BLUE SHIELD
IL
Enumeration date
06/13/2005
Last updated
11/02/2009
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