Provider Demographics
NPI:1841216785
Name:BAUR, REBECCA A (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BAUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMIT DR
Mailing Address - Street 2:LOCKBOX 1131
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1131
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-0350
Practice Address - Country:US
Practice Address - Phone:573-468-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001417363A00000X, 207P00000X
GA004050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO027013209Medicare PIN
MO000097351Medicare PIN
P74853Medicare UPIN
MO000097529Medicare PIN