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NPI Code Detail

MEDICARE: DR. LORI DEROSEAR D.O.

MEDICARE: DR. LORI DEROSEAR D.O.
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
12084P0800XPsychiatry PhysicianR9B93MO

General Provider Information

NPI Number : 1922157056
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORI DEROSEAR D.O.
Provider Business Mailing Address
First Line : 5300 ARSENAL ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63139-1463
Country : US
Telephone Number : 314-877-0589
Fax Number : 314-877-5777
Provider Business Practice Location Address
First Line : 5300 ARSENAL ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63139-1463
Country : US
Telephone Number : 314-877-0589
Fax Number : 314-877-0575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 07/08/2007

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