Healthcare Provider Details

I. General information

NPI: 1982041034
Provider Name (Legal Business Name): LAURA ANN SCHOENEBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5633
  • Fax: 314-268-4141
Mailing address:
  • Phone: 314-577-5633
  • Fax: 713-500-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021021527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: