Provider Demographics
NPI:1013042100
Name:PUNCH, LAURIE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:JEAN
Last Name:PUNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-862-9980
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6163
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015043978208600000X, 2086S0102X, 207LC0200X
TXP71872086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200027894Medicaid
MO1013042100Medicaid
TXP01507452OtherRR MEDICARE
TX8DY837OtherBLUE CROSS BLUE SHIELD
MDP00754019OtherMEDICARE RAILROAD
MD161193AL4Medicare PIN
TX298106YMVQMedicare PIN