Provider Demographics
NPI:1306804489
Name:VAN AMBURG, ALBERT L III (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:VAN AMBURG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:SUITE 330 EAST
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-205-6737
Mailing Address - Fax:314-576-2378
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:SUITE 330 EAST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6737
Practice Address - Fax:314-576-2378
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5296207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201245461Medicaid
MO241963OtherGROUP HEALTH PLAN
MO0280272087OtherILLINOIS PUBLIC AID
MO14488OtherBC/BS OF MISSOURI
MO4061290OtherAETNA
MO44637OtherCIGNA
MO182403OtherHEALTHLINK
MO380214704Medicare PIN
MO182403OtherHEALTHLINK