Organization
DERMATOLOGY CONSULTANTS, P.C.
Active
Other names
FRED D. BAUSCHARD, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED DURLIN BAUSCHARD M.D. (PRESIDENT)
(314) 832-6803
Entity
Organization
Contact information
Practice address
6451 CHIPPEWA ST, SUITE 2, SAINT LOUIS, MO 63109-2104
(314) 832-6803
(314) 832-8072
Mailing address
6451 CHIPPEWA ST, SUITE 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
03/20/2007
Last updated
08/22/2020
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