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General NPI Number Information
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NPI Number | 1356347843
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Entity Type | Individual
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Provider Name | LAWRENCE GLENNON EVANS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3824 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1237
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Country | US
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Telephone | 314-352-4400
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Fax | 314-352-8496
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Provider Business Mailing Address
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Address Line | 3824 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1237
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Country | US
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Telephone | 314-352-4400
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Fax | 314-352-8496
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 31680
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License Number State | MO
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