Provider Demographics
NPI:1922002344
Name:SCHRENK, LOREN CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:CLAYTON
Last Name:SCHRENK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12818 TESSON FERRY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2945
Mailing Address - Country:US
Mailing Address - Phone:314-843-4044
Mailing Address - Fax:314-843-2941
Practice Address - Street 1:12818 TESSON FERRY RD
Practice Address - Street 2:STE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2945
Practice Address - Country:US
Practice Address - Phone:314-843-4044
Practice Address - Fax:314-843-2941
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8F17207W00000X
IL03058639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058639Medicaid
MO202559308Medicaid
IL036058639Medicaid
MO202559308Medicaid
MOA10262Medicare UPIN