Provider Demographics
NPI:1558896894
Name:LENDERMON, JUSTIN BRENT (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BRENT
Last Name:LENDERMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:BRENT
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0127
Mailing Address - Country:US
Mailing Address - Phone:314-770-9393
Mailing Address - Fax:314-770-9997
Practice Address - Street 1:12303 DEPAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-770-9393
Practice Address - Fax:314-770-9997
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230252382085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology