Healthcare Provider Details

I. General information

NPI: 1912524117
Provider Name (Legal Business Name): ANDREW LAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1014
US

IV. Provider business mailing address

660 S EUCLID AVE, CB EMERGENCY MEDICINE
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5000
  • Fax:
Mailing address:
  • Phone: 314-362-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2020016973
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: