Organization
SOUTHEAST MISSOURI ANESTHESIA SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SONJAY JOSEPH FONN DO (OWNER/CEO)
(573) 651-1687
Entity
Organization
Contact information
Practice address
65 DOCTORS PARK STE A, CAPE GIRARDEAU, MO 63703-4927
(573) 651-1687
(573) 651-8734
Mailing address
PO BOX 614, CAPE GIRARDEAU, MO 63702-0614
(573) 651-1687
(573) 651-8734
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008003433
STATE BOARD
MO
Enumeration date
06/13/2013
Last updated
11/18/2020
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