Provider Demographics
NPI:1952383473
Name:BAUER FOGARTY, CHRISTY M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:M
Last Name:BAUER FOGARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:366 CONWAY GARDENS CT
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-275-7746
Mailing Address - Fax:314-275-4005
Practice Address - Street 1:366 CONWAY GARDENS COURT
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-996-5225
Practice Address - Fax:314-275-4005
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMDR315207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206719031Medicaid
MO002013849Medicare PIN
E62015Medicare UPIN