Djamel Bouazza, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2024032260 Issued in MO

Practice address

6420 Clayton Rd
Saint Louis, MO 63117-1811

Phone

(716) 255-6305

NPI assigned

Nov 23, 2024

Last updated

Nov 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732320000000",
    "number": "1457177545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 8TH ST",
            "city": "NIAGARA FALLS",
            "state": "NY",
            "postal_code": "143011758",
            "telephone_number": "716-255-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 CLAYTON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171811",
            "telephone_number": "716-255-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUAZZA",
        "first_name": "DJAMEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-23",
        "last_updated": "2024-11-23",
        "certification_date": "2024-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2024032260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laila M Bottros, MD
• Sara Notowich Botuck
• Halim Bou Daher, MD
• Samer Bou Karroum, MD
• Zeena Bou Reslan, MD
• Rebecca Boucard
• Linda Trinh Boucher, FNP
• Douglas Bouck, Sr., DC
• Pibi Jean Bouda
• Joshua Boudeman, PHARMD

• Internal Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.