Provider Demographics
NPI:1669465852
Name:ROUSE, ANDREW M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:ROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-576-7013
Mailing Address - Fax:314-576-4047
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3497
Practice Address - Country:US
Practice Address - Phone:314-576-7013
Practice Address - Fax:314-576-4047
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7N43207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
10854895OtherCAQH
28651OtherBLUE CROSS BLUE SHIELD
10854895OtherCAQH
28651OtherBLUE CROSS BLUE SHIELD
0355550001Medicare NSC