Provider Demographics
NPI:1811983869
Name:SAMUELS, LAWRENCE E (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:480 NORTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-576-7343
Mailing Address - Fax:314-576-7929
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:480 NORTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-576-7343
Practice Address - Fax:314-576-7929
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7821207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSTL0300034OtherUNITED HEALTHCARE
MOFIRST HEALTHOther5226978
MO4228309OtherAETNA
MO125936OtherHEALTHLINK
MO2681938001OtherCIGNA
MO32276OtherGROUP HEALTH PLAN
MO828013496OtherRAILROAD MEDICARE
MO22849OtherBLUE SHIELD
MOCN5366OtherRR MEDICARE
MO000001270Medicare PIN
MOFIRST HEALTHOther5226978