Healthcare Provider Details

I. General information

NPI: 1346683059
Provider Name (Legal Business Name): TIMOTHY MICHAEL LONERGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR STE 1300
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

901 PATIENTS FIRST DR STE 1300
WASHINGTON MO
63090-4700
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-9011
  • Fax: 636-239-0433
Mailing address:
  • Phone: 636-239-9011
  • Fax: 636-239-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number52379
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number2025014331
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: