Individual
DR. JOHN JOSEPH BONACORSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12277 DE PAUL DR, STE. 502S, BRIDGETON, MO 63044-2516
(314) 291-5307
(314) 291-0838
Mailing address
12277 DE PAUL DR, STE. 502S, BRIDGETON, MO 63044-2516
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R5611
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001013172
PTAN
MO
05
—
200165504
—
MO
Enumeration date
08/30/2006
Last updated
09/14/2011
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