Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | R7172 | MO |
NPI | 1003943523 |
---|---|
Provider Name | Daniel B Bauwens |
First Address | Chesterfield, MO 63017-3417 |
Second Address | Chesterfield, MO 63017-3417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A09942 | (02) | MO |