Provider Demographics
NPI:1427055961
Name:MCCLINTON, LAWRENCE (PA)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:MCCLINTON
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 RUTGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2515
Mailing Address - Country:US
Mailing Address - Phone:314-977-5782
Mailing Address - Fax:314-977-1628
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-5555
Practice Address - Fax:314-257-5556
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110249363A00000X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085000213OtherLICENSE
MO110249OtherLICENSE
IL546190OtherMEDICARE GROUP NUMBER
IL085000213OtherLICENSE
ILIL3521032Medicare PIN
IL546190OtherMEDICARE GROUP NUMBER