MEDICARE: THOMAS J. STAUDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	105229	MO
2	207KA0200X	Allergy Physician	105229	MO
3	207P00000X	Emergency Medicine Physician	105229	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	383495136	OTHER	MO	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679568570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J. STAUDER MD

Provider Business Mailing Address
First Line	:	1906 POWDERHORN PASS CT
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63011-1717
Country	:	US
Telephone Number	:	636-458-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 POWDERHORN PASS CT
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63011-1717
Country	:	US
Telephone Number	:	636-458-4188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	11/23/2009

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Directions to “ THOMAS J. STAUDER MD” Practice Location

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