Provider Demographics
NPI:1669734851
Name:LAI, VINCE J (MD)
Entity type:Individual
Prefix:MR
First Name:VINCE
Middle Name:J
Last Name:LAI
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 1:621 S NEW BALLAS RD STE 3005B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8266
Mailing Address - Country:US
Mailing Address - Phone:314-567-5850
Mailing Address - Fax:314-567-9169
Practice Address - Street 1:621 S NEW BALLAS RD STE 3005B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8266
Practice Address - Country:US
Practice Address - Phone:314-567-5850
Practice Address - Fax:314-567-9169
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-01-03
Deactivation Date:2018-11-29
Deactivation Code:
Reactivation Date:2018-12-05
Provider Licenses
StateLicense IDTaxonomies
MO2018010083207XX0005X, 207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine