Individual
HUMBERTO M FAGUNDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3015 N NEW BALLAS RD, ST LOUIS, MO 63131
(314) 996-5180
(314) 821-2180
Mailing address
55 W PORT PLZ, SUITE 300, SAINT LOUIS, MO 63146-3109
(314) 548-4772
(314) 548-4748
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
100121
MO
2085R0202X
Diagnostic Radiology Physician
100121
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100121
MO LICENSE
—
01
—
207947516
MCAID
—
01
—
32286
BNDD
—
01
—
33012444
CPIN
—
01
—
920004686
RRMEDICARE
—
Enumeration date
08/29/2006
Last updated
03/07/2023
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