Provider Demographics
NPI:1447344411
Name:BILLY, LAWRENCE J (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:BILLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-0108
Mailing Address - Country:US
Mailing Address - Phone:314-795-7168
Mailing Address - Fax:636-797-2611
Practice Address - Street 1:3933 S BROADWAY
Practice Address - Street 2:LIMB PRESERVATION CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4601
Practice Address - Country:US
Practice Address - Phone:314-256-7301
Practice Address - Fax:314-865-7009
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO30514208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200026920Medicaid
MOA10912Medicare UPIN
MO200026920Medicaid