Healthcare Provider Details

I. General information

NPI: 1699889964
Provider Name (Legal Business Name): LEE ALLEN RIGG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLZ SUITE 221
LAKE SAINT LOUIS MO
63367-1481
US

IV. Provider business mailing address

504 FOREST CRST
LAKE SAINT LOUIS MO
63367-2440
US

V. Phone/Fax

Practice location:
  • Phone: 696-625-7730
  • Fax: 636-625-5288
Mailing address:
  • Phone: 636-561-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number33606
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: