Healthcare Provider Details

I. General information

NPI: 1356332761
Provider Name (Legal Business Name): DONALD HENRY LANGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CEDAR PLAZA PKWY SUITE 230
SAINT LOUIS MO
63128-3854
US

IV. Provider business mailing address

5000 CEDAR PLAZA PKWY SUITE 230
SAINT LOUIS MO
63128-3854
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-7372
  • Fax: 314-849-7347
Mailing address:
  • Phone: 314-849-7372
  • Fax: 314-849-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberR1B73
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: