Provider Demographics
NPI:1063775716
Name:LANGE, MATTHEW A (DO)
Entity type:Individual
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First Name:MATTHEW
Middle Name:A
Last Name:LANGE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:456 N NEW BALLAS RD STE 386
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6846
Mailing Address - Country:US
Mailing Address - Phone:314-887-7605
Mailing Address - Fax:314-887-7609
Practice Address - Street 1:456 N NEW BALLAS RD STE 386
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6846
Practice Address - Country:US
Practice Address - Phone:314-887-7605
Practice Address - Fax:314-887-7609
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2023-10-03
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Provider Licenses
StateLicense IDTaxonomies
MO2018016254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery