Provider Demographics
NPI:1003841388
Name:BOVERI, LAWRENCE VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:VINCENT
Last Name:BOVERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:VINCENT
Other - Last Name:BOVERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1011 BOWLES AVE.
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3287
Mailing Address - Country:US
Mailing Address - Phone:636-680-1960
Mailing Address - Fax:636-680-1961
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:636-680-1960
Practice Address - Fax:636-680-1964
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7P94207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207951500Medicaid
MO207951500Medicaid
F40269Medicare UPIN