Healthcare Provider Details

I. General information

NPI: 1235191321
Provider Name (Legal Business Name): LEI GUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 WOLLARD BLVD RAY COUNTY MEMORIAL HOSPITAL
RICHMOND MO
64085-2229
US

IV. Provider business mailing address

251 PALISADES RIDGE CT
EUREKA MO
63025-3706
US

V. Phone/Fax

Practice location:
  • Phone: 816-470-5432
  • Fax: 816-470-8382
Mailing address:
  • Phone: 636-587-2998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2004017276
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: