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Individual

DR. JOHNNY TAN LU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
12647 OLIVE BLVD, SAINT LOUIS, MO 63141-6393
(800) 325-3982
(877) 685-9866
Mailing address
12647 OLIVE BLVD, SAINT LOUIS, MO 63141-6393
(800) 325-3982
(877) 685-9866

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101221438
VA

Other

Enumeration date
04/15/2011
Last updated
04/15/2011
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