Provider Demographics
NPI:1578544763
Name:BAUDLER, ALAN J (CRNA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:BAUDLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:BAUDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:361 MORGAN MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:EOLIA
Mailing Address - State:MO
Mailing Address - Zip Code:63344-2236
Mailing Address - Country:US
Mailing Address - Phone:314-265-8598
Mailing Address - Fax:
Practice Address - Street 1:361 MORGAN MEADOWS LN
Practice Address - Street 2:
Practice Address - City:EOLIA
Practice Address - State:MO
Practice Address - Zip Code:63344-2236
Practice Address - Country:US
Practice Address - Phone:314-265-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044374367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO918518564Medicaid
MO430068228OtherRAILROAD MEDICARE
MO007060175Medicare PIN