Provider Demographics
NPI:1679560759
Name:BADER, ERIC J W (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J W
Last Name:BADER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-0005
Mailing Address - Country:US
Mailing Address - Phone:314-895-3828
Mailing Address - Fax:314-895-3827
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:314-895-3828
Practice Address - Fax:314-895-3827
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO105825207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO247740400Medicaid
050030948OtherRAILROAD MEDICARE
MO247740400Medicaid
050030948OtherRAILROAD MEDICARE