Individual
TIMOTHY C LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3555 SUNSET OFFICE DR, SUITE 101, SAINT LOUIS, MO 63127-1015
(314) 966-0252
Mailing address
3555 SUNSET OFFICE DR, SUITE 107, SAINT LOUIS, MO 63127-1015
(314) 822-5914
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
103240
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209684513
—
MO
Enumeration date
05/25/2006
Last updated
02/04/2013
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