Allen D Baudendistel, M.D.

Individual provider Active NPI Anesthesiology Physician · Saint Louis, MO

NPI 1861497604 · NPPES record last updated Feb 19, 2008

Key facts

NPI
1861497604
Entity type
Individual (NPI type 1)
Primary specialty
Anesthesiology Physician 207L00000X
License
R1K01 (MO)
Practice address
3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone
(314) 996-5330
Fax
(314) 810-1399
NPI assigned
Jun 17, 2005
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R1K01MOMDAnesthesiology Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X R1K01 MO Yes

Addresses

Primary practice location

3015 N Ballas Rd
Saint Louis, MO 63131-2329

Mailing address

2931 Devondale PL
Saint Louis, MO 63131-2520

Other providers in Saint Louis, MO

All providers in Saint Louis, MO · Anesthesiology Physician in Missouri

Sources for this page

Verify at the official NPI Registry.