Individual
DR. THOMAS MARK LEIBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 MEDICAL PLZ STE 310, LAKE ST LOUIS, MO 63367-1484
(636) 625-2662
(636) 625-6623
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2006017165
MO
Other
Enumeration date
07/05/2006
Last updated
10/23/2020
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