Individual
EDWARD STEPHEN BOLESTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1402 S GRAND, ST LOUIS, MO 63104
(314) 577-8000
Mailing address
3691 RUTGER ST, SAINT LOUIS, MO 63110-2515
(314) 977-6828
(314) 977-6777
Taxonomy
Speciality
Code
Description
License number
State
207ZF0201X
Forensic Pathology Physician
36579
MO
207ZP0101X
Anatomic Pathology Physician
Primary
36579
MO
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
36579
MO
Other
Enumeration date
07/28/2006
Last updated
01/17/2017
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