Individual
VINCENT P. FORTUNATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2325 DOUGHERTY FERRY RD STE 104, SAINT LOUIS, MO 63122-3356
(148) 216-8893
(314) 821-1887
Mailing address
10004 KENNERLY RD, SUITE #255A, SAINT LOUIS, MO 63128-2141
(314) 843-5140
(314) 843-8010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R1J64
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110080662
RAILROAD MEDICARE
MO
01
—
173933
HEALTHLINK
MO
05
—
206760100
—
MO
01
—
21532
BLUE CROSS
MO
01
—
4084340
AETNA
MO
01
—
431650657
CIGNA HEALTHCARE
MO
01
—
9499441
UNITED HEALTHCARE
MO
Enumeration date
12/09/2005
Last updated
08/28/2020
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