Individual
DR. PETER FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12266 DE PAUL DR STE 205, BRIDGETON, MO 63044-2514
(314) 647-8269
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
116658
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507190205
—
MO
Enumeration date
08/09/2005
Last updated
11/05/2020
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