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General NPI Number Information
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NPI Number | 1427055961
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Entity Type | Individual
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Provider Name | LAWRENCE MCCLINTON PA
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1201 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1016
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Country | US
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Telephone | 314-257-5555
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Fax | 314-257-5556
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Provider Business Mailing Address
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Address Line | 3691 RUTGER ST
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2515
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Country | US
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Telephone | 314-977-5782
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Fax | 314-977-1628
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 110249
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 110249
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License Number State | MO
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