Provider Demographics
NPI:1710129630
Name:DEPALMA, LAURA CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CHRISTINE
Last Name:DEPALMA
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8233
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2500
Mailing Address - Fax:314-747-2598
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 6A/6B/12A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-2500
Practice Address - Fax:314-747-2598
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2019-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2017032648208000000X, 2080P0204X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO200048988Medicaid
NCNCC295AMedicare PIN