Basic Information
| Provider Information | |||||||||
| NPI: | 1346221090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUNCH | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147394166 | ||||||||
| FaxNumber: | 3147392485 | ||||||||
| Practice Location | |||||||||
| Address1: | 12255 DE PAUL DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147394166 | ||||||||
| FaxNumber: | 3147392485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 09/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R2J26 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000012460 | 01 | MO | ESSENCE ST CHARLES | OTHER | 202580411 | 05 | MO | MEDICAID | A25928 | 01 | MO | MERCY | OTHER | 109346 | 01 | MO | BCBS | OTHER | 5418213 | 01 | MO | AETNA | OTHER | 0400842 | 01 | MO | UHC | OTHER | D04008 | 01 | MO | EXCLUSIVE CHOICE | OTHER | 000000010023 | 01 | MO | ESSENCE | OTHER | 103088 | 01 | MO | HEALTHLINK | OTHER | 127510 | 01 | MO | GHP | OTHER |