Provider Demographics
NPI:1053336859
Name:RAUCHWAY, AMY C (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:RAUCHWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 TOWN & COUNTRY COMMONS
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:636-893-1260
Mailing Address - Fax:
Practice Address - Street 1:1176 TOWN AND COUNTRY COMMONS
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8200
Practice Address - Country:US
Practice Address - Phone:636-893-1260
Practice Address - Fax:636-893-1261
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050114202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00987639OtherRAILROAD MEDICARE
MO1053336859Medicaid
MO1053336859Medicaid