NPI 1144577305

Blue Bayou Service INC

Organisation General Practice Physician Saint Louis, MO

Practice location

Address: 1310 Papin St, Saint Louis, MO 63103-3132
Phone: (314) 502-1300

Authorised official

Name: William Bronson
Title: Ceo
Phone: (314) 502-1300

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 12345 (MO)

Other General Practice providers in Missouri →

Registry record

NPI: 1144577305
Entity type: Organization
NPI issued: 7 Aug 2012
Record last updated: 18 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.