Provider Demographics
NPI:1225179724
Name:LAWRENCE E. SAMUELS M.D., INC.
Entity Type:Organization
Organization Name:LAWRENCE E. SAMUELS M.D., INC.
Other - Org Name:SPECIALISTS IN DERMATOLOGY AND COSMETIC MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-576-7343
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:480 NORTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-576-7343
Mailing Address - Fax:314-576-7929
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:480 NORTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-576-7343
Practice Address - Fax:314-576-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty