Provider Demographics
NPI:1962469494
Name:LAHUE, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:LAHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S 13 HWY STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1572
Mailing Address - Country:US
Mailing Address - Phone:660-259-3823
Mailing Address - Fax:
Practice Address - Street 1:811 S 13 HWY STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1572
Practice Address - Country:US
Practice Address - Phone:660-259-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595956400Medicaid
MO595956202Medicaid
MO010568509Medicaid
04387087OtherBCBS
04387097OtherBCBS
MO200691038Medicaid
MO540568508Medicaid
P00385975Medicare PIN
P270000Medicare PIN
MO010568509Medicaid
P272768Medicare ID - Type Unspecified
MO540568508Medicaid
04387087OtherBCBS
268549Medicare Oscar/Certification
DA4239Medicare PIN