Individual
DR. ANTONIO R PENILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1225 GRAHAM RD, STE 2310C, FLORISSANT, MO 63031-8012
(314) 953-6300
(314) 953-6309
Mailing address
670 MASON RIDGE CENTER DR, STE. 300, SAINT LOUIS, MO 63141-8573
(314) 953-6300
(314) 953-6309
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
33875
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200920817
—
MO
01
—
7480467052
IDPA
IL
01
—
P00320613
RR MCR
—
Enumeration date
07/20/2005
Last updated
01/30/2013
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