Individual
MR. LAWRENCE MCCLINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 257-5555
(314) 257-5556
Mailing address
3691 RUTGER ST, SAINT LOUIS, MO 63110-2515
(314) 977-5782
(314) 977-1628
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
110249
MO
363A00000X
Physician Assistant
110249
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085000213
LICENSE
IL
01
—
110249
LICENSE
MO
01
—
546190
MEDICARE GROUP NUMBER
IL
Enumeration date
06/30/2005
Last updated
03/20/2025
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