MEDICARE: DR. DWIGHT C LOOK III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	34042	IA
2	207RP1001X	Pulmonary Disease Physician	34042	IA

General Provider Information

NPI Number	:	1386631430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT C LOOK III MD

Provider Business Mailing Address
First Line	:	12595 PRIVATE DRIVE 8012
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401-8555
Country	:	US
Telephone Number	:	319-621-9536
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1621
Country	:	US
Telephone Number	:	314-652-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	04/02/2024

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