Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 014805 | MO |
N | 213EG0000X | General Practice | 014805 | MO |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 014805 | MO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 105827 | MO |
N | 208200000X | Surgeon | 036086950 | IL |
N | 208600000X | Surgeon | 036086950 | IL |
Y | 208200000X | Surgeon | 105827 | MO |
Y | 208600000X | Surgeon | 105827 | MO |
N | 2082S0105X | Plastic Hand Surgeon | 105827 | MO |
N | 2086S0122X | Plastic and Reconstructive Surgery | 105827 | MO |
NPI | 1346342920 |
---|---|
Provider Name | Dr. Stanley L Librach |
First Address | Chesterfield, MO 63017-4771 |
Second Address | Chesterfield, MO 63017-4771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 22/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036086950 | (05) | IL |
08232029 | BLUE SHIELD (01) | IL |
122497 | BLUE SHIELD (01) | MO |
206971236 | (05) | MO |
F69557 | (02) |