Provider Demographics
NPI:1235143942
Name:ZHANG, LAISHANG PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAISHANG
Middle Name:PETER
Last Name:ZHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CRAIG RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7190
Mailing Address - Country:US
Mailing Address - Phone:314-991-2500
Mailing Address - Fax:314-991-2504
Practice Address - Street 1:777 CRAIG RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7138
Practice Address - Country:US
Practice Address - Phone:314-991-2500
Practice Address - Fax:314-991-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020280802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208324806Medicaid
MOH43240Medicare UPIN
MO001013956Medicare PIN