Provider Demographics
NPI:1477537975
Name:LAVALLE, CHARLES E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:LAVALLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 191850
Mailing Address - Street 2:ATTN: DEBBIE STRAUSS
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-7850
Mailing Address - Country:US
Mailing Address - Phone:314-821-8055
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:ATTN: INFECTIOUS DISEASE DEPT
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-3000
Practice Address - Fax:573-331-3000
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-06-06
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Provider Licenses
StateLicense IDTaxonomies
MO115503207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207801200Medicare ID - Type UnspecifiedINDIVIDUAL
MO002013845Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
MOH83388Medicare UPIN