Healthcare Provider Details

I. General information

NPI: 1851456958
Provider Name (Legal Business Name): KEVIN D BUCOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/15/2021
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD DEPT ANESTHESIOLOGY
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8054
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 800-862-9980
  • Fax: 314-362-1185
Mailing address:
  • Phone: 800-862-9980
  • Fax: 314-362-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR3D89
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: