Crock, Lara Wiley

Crock, Lara Wiley is an individual health care provider with primary practice located at 4921 Parkview Pl Dept Anesthesiology, Ste 14C, Saint Louis MO 63110-1032. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is her primary health care specialty. Crock, Lara Wiley can be contacted via phone (314) 362-8820.

Contact Information

Primary practice address
4921 Parkview Pl Dept Anesthesiology, Ste 14C Saint Louis MO 63110-1032
Phone: (314) 362-8820
Fax: (314) 362-1185
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 2016006386 Missouri
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 2016006386 Missouri

Profile Details

NPI number 1669811816
LBN Legal business name Crock, Lara Wiley
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2013
Last updated Apr 25th, 2024 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669811816 NPPES
Missouri MEDICAID 200058547

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