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General NPI Number Information
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NPI Number | 1013042100
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Entity Type | Individual
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Provider Name | LJ PUNCH MD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 5501 DELMAR BLVD STE A430
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City | SAINT LOUIS
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State | MO
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Zip | 63112-3079
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Country | US
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Telephone | 314-624-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 DELMAR BLVD STE A430
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City | SAINT LOUIS
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State | MO
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Zip | 63112-3079
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Country | US
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Telephone | 314-306-4378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 2015043978
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 2015049378
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2015043978
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License Number State | MO
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