Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | R7P94 | MO |
NPI | 1003841388 |
---|---|
Provider Name | Dr. Lawrence Vincent Boveri |
First Address | Fenton, MO 63028-3287 |
Second Address | Fenton, MO 63026-2395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207951500 | (05) | MO |
F40269 | (02) |