Individual
DR. TERESA LORRAINE LODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
(417) 967-5503
Mailing address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
(417) 967-5503
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
1476
NE
208000000X
Pediatrics Physician
Primary
2018008048
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200053618
—
MO
01
—
26D0889777
CLIA
MO
Enumeration date
06/05/2013
Last updated
06/25/2018
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