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NPI Code Detail

MEDICARE: JOSH LANTER

MEDICARE:   JOSH  LANTER
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
1390200000XStudent in an Organized Health Care Education/Training Program2002014689MO

General Provider Information

NPI Number : 1710180609
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSH LANTER
Provider Business Mailing Address
First Line : 1526 MENARD ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-3714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1526 MENARD ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-3714
Country : US
Telephone Number : 314-436-4538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2007
Last Update Date : 07/08/2007

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Directions to “ JOSH LANTER ” Practice Location

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