Individual
TERESA MARIE BLASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 S NEW BALLAS RD, EMERGENCY DEPARTMENT, SAINT LOUIS, MO 63141-8221
(314) 251-6090
Mailing address
314 WOODCLIFFE PLACE DR, CHESTERFIELD, MO 63005-4817
(636) 532-6546
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
103651
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821100553
—
MO
Enumeration date
08/31/2006
Last updated
03/10/2015
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