Individual
LAWRENCE EVAN WIBBELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 PARKLAND DR, FARMINGTON, MO 63640-2906
(573) 756-8000
(576) 756-8288
Mailing address
2851 WATSON RD, PARK HILLS, MO 63601-8123
(573) 760-0097
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MDR8G40
MO
261QA1903X
Ambulatory Surgical Clinic/Center
R8G40
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202404877
—
MO
Enumeration date
12/27/2006
Last updated
11/20/2015
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