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General NPI Number Information
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NPI Number | 1659868040
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Entity Type | Individual
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Provider Name | WILLIAM LOUIS HOLLABAUGH MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 20 PROGRESS POINT PKWY DEPT ORTHOPAEDIC SURGERY, STE 114
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City | O FALLON
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State | MO
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Zip | 63368-2206
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Country | US
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Telephone | 314-514-3500
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Fax | 314-878-7678
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-514-3500
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Fax | 314-878-7678
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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 | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | 2024016238
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License Number State | MO
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