Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | R6388 | MO |
N | 207XS0117X | Orthopaedic Spine Surgeon | R6388 | MO |
NPI | 1154316784 |
---|---|
Provider Name | David R. Lange |
First Address | St. Louis, MO 63131 |
Second Address | Saint Louis, MO 63141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A14086 | (02) |