Organization
EDWARDO D VERZOLA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARDO D VERZOLA MD (CEO)
(636) 937-8675
Entity
Organization
Contact information
Practice address
1004 HERCULANEUM INDUSTRIAL DR, HERCULANEUM, MO 63048-1507
(636) 937-8675
(636) 933-1981
Mailing address
1004 HERCULANEUM INDUSTRIAL DR, P O BOX 127, HERCULANEUM, MO 63048-1507
(636) 937-8675
(636) 933-1981
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
2000161966
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00094938
MEDICARE PROVIDER #
—
01
—
10856311
CAQH
—
01
—
2000161966
MO LICENSE
MO
05
—
VE205099708
—
MO
Enumeration date
11/20/2009
Last updated
11/20/2009
Update your record
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