Provider Demographics
NPI:1689038077
Name:BAJALA, DEANNA JUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:JUSTINE
Last Name:BAJALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:175 N OAKS PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-2925
Mailing Address - Country:US
Mailing Address - Phone:314-391-9777
Mailing Address - Fax:314-390-5404
Practice Address - Street 1:175 N OAKS PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-2925
Practice Address - Country:US
Practice Address - Phone:314-391-9777
Practice Address - Fax:314-390-5404
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2019025551207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine