Healthcare Provider Details

I. General information

NPI: 1902566458
Provider Name (Legal Business Name): MR. DAVID JAMES LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2021
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 MANCHESTER AVE
SAINT LOUIS MO
63110-2138
US

IV. Provider business mailing address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111-2410
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-5190
  • Fax:
Mailing address:
  • Phone: 314-353-5190
  • Fax: 314-353-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021050226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: