Provider Demographics
NPI:1437112547
Name:ANGLO, LUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:J
Last Name:ANGLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 S NEW BALLAS RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8702
Mailing Address - Country:US
Mailing Address - Phone:314-251-8850
Mailing Address - Fax:314-569-3846
Practice Address - Street 1:701 S NEW BALLAS RD STE 330
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8702
Practice Address - Country:US
Practice Address - Phone:314-251-8850
Practice Address - Fax:314-569-3846
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1P44208800000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00195679OtherPALMETTO RR MEDIARE
MO925784400Medicare PIN
MOG03052Medicare UPIN