Healthcare Provider Details

I. General information

NPI: 1821327099
Provider Name (Legal Business Name): ST. LOUIS LASER & VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14897 CLAYTON RD SUITE 100
CHESTERFIELD MO
63017-7887
US

IV. Provider business mailing address

14897 CLAYTON RD SUITE 100
CHESTERFIELD MO
63017-7887
US

V. Phone/Fax

Practice location:
  • Phone: 636-391-1706
  • Fax: 636-391-1201
Mailing address:
  • Phone: 636-391-1706
  • Fax: 636-391-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number100898
License Number StateMO

VIII. Authorized Official

Name: DR. ROQUE S RAMOS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 636-391-1706