Individual
DR. PETER A FAHNESTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2005018590
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207406307
—
MO
Enumeration date
07/14/2006
Last updated
08/08/2012
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