Individual
LAURANCE MONCKTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4 MEMORIAL DR, STE 230, ALTON, IL 62002-6751
(618) 462-3191
(618) 462-3379
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(618) 462-3191
(618) 462-3379
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036074993
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360749932
—
IL
Enumeration date
08/02/2006
Last updated
11/13/2012
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