Provider Demographics
NPI:1215094677
Name:VOLLMAR, LEWIS COLNON (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:COLNON
Last Name:VOLLMAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-842-4840
Mailing Address - Fax:314-842-4951
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-842-4840
Practice Address - Fax:314-842-4951
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMD34614207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11410Medicare UPIN