Healthcare Provider Details

I. General information

NPI: 1053336859
Provider Name (Legal Business Name): AMY C RAUCHWAY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 TOWN AND COUNTRY COMMONS
CHESTERFIELD MO
63017-8200
US

IV. Provider business mailing address

1176 TOWN & COUNTRY COMMONS
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 636-893-1260
  • Fax: 636-893-1261
Mailing address:
  • Phone: 636-893-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2005011420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: