Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2015043978 | MO |
N | 208600000X | Surgeon | 2015043978 | MO |
N | 2086S0102X | Surgical Critical Care | 2015043978 | MO |
NPI | 1013042100 |
---|---|
Provider Name | Dr. Laurie Jean Punch |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63136-6163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200027894 | (05) | MO |