MEDICARE: DR. LISA RAE MOHRMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2013045164	MO

General Provider Information

NPI Number	:	1144465519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA RAE MOHRMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 959354
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-9354
Country	:	US
Telephone Number	:	573-705-1298
Fax Number	:	573-760-8293

Provider Business Practice Location Address
First Line	:	6400 CLAYTON RD STE 303
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1850
Country	:	US
Telephone Number	:	314-408-7756
Fax Number	:	314-207-4943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	04/10/2026

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