Basic Information
| Provider Information | |||||||||
| NPI: | 1598143471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAPONSIE | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 E MAIN ST | ||||||||
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| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630281952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369312700 | ||||||||
| FaxNumber: | 6369315304 | ||||||||
| Practice Location | |||||||||
| Address1: | 1817 GRAVOIS RD | ||||||||
| Address2: | |||||||||
| City: | HIGH RIDGE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630492668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363760079 | ||||||||
| FaxNumber: | 6366778440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2015 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.