Provider Demographics
NPI:1720004955
Name:LA BORE, ADAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOSEPH
Last Name:LA BORE
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Gender:M
Credentials:MD
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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:314-996-3019
Practice Address - Street 1:14532 S OUTER 40 RD
Practice Address - Street 2:STE 200
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5705
Practice Address - Country:US
Practice Address - Phone:314-514-3913
Practice Address - Fax:314-514-3534
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-12-08
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Provider Licenses
StateLicense IDTaxonomies
MO2003000102208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208800615Medicaid
ILENROLLEDMedicaid
MO918380232Medicaid
MOP00193010Medicare PIN