Organization
PETER FONSECA MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER FONSECA MD (PRESIDENT)
(314) 543-5252
Entity
Organization
Contact information
Practice address
10004 KENNERLY, SUITE 345A, ST. LOUIS, MO 63128
(314) 543-5252
(314) 543-5211
Mailing address
10004 KENNERLY, SUITE 345A, ST. LOUIS, MO 63128
(314) 543-5252
(314) 543-5211
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
116658
MO
Other
Enumeration date
05/04/2007
Last updated
01/04/2010
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