Provider Demographics
NPI:1952413023
Name:BEHM, FREDERICK VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:VINCENT
Last Name:BEHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-965-6033
Mailing Address - Fax:314-965-6067
Practice Address - Street 1:10345 WATSON RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-965-6033
Practice Address - Fax:314-965-6067
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10278207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3323OtherMEDICARE NUMBER 3323
MO3323OtherMEDICARE NUMBER 3323
MO57749Medicare PIN
F57749Medicare UPIN