Bonacorsi, John Joseph
Bonacorsi, John Joseph is an individual health care provider with primary practice located at 12277 De Paul Dr Ste. 502S, Bridgeton MO 63044-2516. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Bonacorsi, John Joseph can be contacted via phone (314) 291-5307.Contact Information
Primary practice address
12277 De Paul Dr Ste. 502S
Bridgeton MO 63044-2516
Phone: (314) 291-5307
Fax: (314) 291-0838
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | R5611 | Missouri |
Profile Details
| NPI number | 1265541395 |
|---|---|
| LBN Legal business name | Bonacorsi, John Joseph |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Sep 14th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265541395 | NPPES |
| Missouri | MEDICAID | 200165504 | |
| Missouri | Other | 001013172 |
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