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General NPI Number Information
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NPI Number | 1952411860
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Entity Type | Individual
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Provider Name | LAWRENCE L. DYBEDOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 10763 HIGHWAY 39 STE. 200
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City | MOUNT VERNON
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State | MO
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Zip | 65712-7823
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Country | US
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Telephone | 417-269-2460
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Fax | 417-269-2462
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Provider Business Mailing Address
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Address Line | PO BOX 505673
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City | SAINT LOUIS
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State | MO
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Zip | 63150-5673
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Country | US
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Telephone | 417-730-6430
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Fax | 417-269-7567
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004036071
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License Number State | MO
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