Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | R1B73 | MO |
NPI | 1356332761 |
---|---|
Provider Name | Donald Henry Lange |
First Address | Saint Louis, MO 63128-3854 |
Second Address | Saint Louis, MO 63128-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 08/07/2007 |