Healthcare Provider Details

I. General information

NPI: 1215548540
Provider Name (Legal Business Name): BLAKE FREDERICK BUEHRER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 07/14/2025
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GRAHAM RD DEPT EMERGENCY MEDICINE
FLORISSANT MO
63031-8012
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-9123
  • Fax: 314-747-9160
Mailing address:
  • Phone: 314-362-9123
  • Fax: 314-747-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2022004072
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: