Healthcare Provider Details

I. General information

NPI: 1669647962
Provider Name (Legal Business Name): CAROLE LADRIERE MCLAUGHLIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 75, TOWER B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

320 N MOSLEY RD
SAINT LOUIS MO
63141-7629
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7564
  • Fax: 314-251-7554
Mailing address:
  • Phone: 314-432-8584
  • Fax: 314-432-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number103956
License Number StateMO

VIII. Authorized Official

Name: DR. CAROLE LADRIERE MCLAUGHLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-993-8584