Provider Demographics
NPI:1386679660
Name:BOVERI, STEPHEN ANGELO (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANGELO
Last Name:BOVERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1011 BOWLES AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2395
Mailing Address - Country:US
Mailing Address - Phone:636-680-1960
Mailing Address - Fax:636-680-1964
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:636-680-1960
Practice Address - Fax:636-680-1964
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO112092207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208651604Medicaid
MO000000088Medicare ID - Type Unspecified
MO208651604Medicaid