Provider Demographics
NPI:1407987829
Name:LEMOINE, DONALD W II (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:LEMOINE
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:618-463-7600
Mailing Address - Fax:618-463-7601
Practice Address - Street 1:4 MEMORIAL DRIVE
Practice Address - Street 2:STE 130B
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4707
Practice Address - Country:US
Practice Address - Phone:618-463-7600
Practice Address - Fax:618-463-7601
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-11-11
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Provider Licenses
StateLicense IDTaxonomies
MO102535363A00000X
IL085000615363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant