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Individual

DR. STANLEY L LIBRACH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
16216 BAXTER RD, STE 325, CHESTERFIELD, MO 63017-4771
(314) 699-4013
(314) 699-4014
Mailing address
16216 BAXTER RD, STE 325, CHESTERFIELD, MO 63017-4771
(314) 699-4013
(314) 699-4014

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
014805
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
014805
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
105827
MO
208200000X
Plastic Surgery Physician
036086950
IL
208200000X
Plastic Surgery Physician
Primary
105827
MO
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
105827
MO
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
105827
MO
2086S0122X
Plastic and Reconstructive Surgery Physician
105827
MO
208VP0014X
Interventional Pain Medicine Physician
105827
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036086950
IL
01
08232029
BLUE SHIELD
IL
01
122497
BLUE SHIELD
MO
05
206971236
MO
Enumeration date
09/02/2006
Last updated
02/22/2018
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