Organization
DERMATOLOGY CONSULTANTS, P.C.
Active
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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