Provider Demographics
NPI:1730316290
Name:GLOVER-COLLINS, KATHERINE LUBELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LUBELL
Last Name:GLOVER-COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-2280
Mailing Address - Fax:888-352-8360
Practice Address - Street 1:1225 GRAHAM RD
Practice Address - Street 2:DIV SURG ONCOLOGY
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8012
Practice Address - Country:US
Practice Address - Phone:314-362-2280
Practice Address - Fax:888-352-8360
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015023839208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200029010Medicaid
ILENROLLEDMedicaid