=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215548540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BLAKE FREDERICK BUEHRER PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2020
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 GRAHAM RD DEPT EMERGENCY MEDICINE
-----------------------------------------------------
City | FLORISSANT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63031-8012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-362-9123
-----------------------------------------------------
Fax | 314-747-9160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7412011
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60674-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-362-9123
-----------------------------------------------------
Fax | 314-747-9160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 2022004072
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------