Provider Demographics
NPI:1982607578
Name:BOUREY, RAYMOND E (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:BOUREY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-3500
Mailing Address - Fax:314-230-1119
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM ENDOCRINOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-3500
Practice Address - Fax:314-230-1119
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014014942207R00000X, 207RE0101X
MO2014014492207RS0012X, 207R00000X, 207RE0101X, 207RS0010X
OH35-066898207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203103809Medicaid
OHC45026Medicare UPIN