Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 2010008621 | MO |
N | 207RC0000X | Internist - Cardiovascular Disease | 2010008621 | MO |
NPI | 1295990315 |
---|---|
Provider Name | Dr. Kory Joshua Lavine |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63141-6666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200014995 | (05) | MO |