Individual
DR. LARA WILEY CROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4921 PARKVIEW PL, DEPT ANESTHESIOLOGY, STE 14C, SAINT LOUIS, MO 63110-1032
(314) 362-8820
(314) 747-2173
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-8820
(314) 747-2173
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2016006386
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2016006386
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200058547
—
MO
Enumeration date
06/20/2013
Last updated
04/17/2025
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