Provider Demographics
NPI:1699834739
Name:BAUERLE, STEPHANIE DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE
Last Name:BAUERLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:DIANE
Other - Last Name:DANIELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:320 BUCKHURST DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8346
Mailing Address - Country:US
Mailing Address - Phone:636-527-9141
Mailing Address - Fax:636-527-9141
Practice Address - Street 1:1780 OLD US HIGHWAY 50 E
Practice Address - Street 2:SUITE 115
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-3397
Practice Address - Country:US
Practice Address - Phone:636-583-8555
Practice Address - Fax:636-583-8559
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine