Healthcare Provider Details

I. General information

NPI: 1528418852
Provider Name (Legal Business Name): SARA LARUE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD OBSTETRICS & GYNECOLOGY
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD OBSTETRICS & GYNECOLOGY
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6062
  • Fax: 314-251-4376
Mailing address:
  • Phone: 314-251-6062
  • Fax: 314-251-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2016020364
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: